Posted by Benjamin Zappin, LAc on Jun 7th 2022
People of all ages, shapes, sexes, and abilities think about and have sex. But when it comes to talking about sexual health, well, that’s another story. In our medical and acupuncture practices, we’ve noticed that while some patients will schedule a visit specifically to address sexual concerns, many more will throw out a sex-related question right as they’re about to walk out the door from an unrelated appointment (“Doc, one more thing I meant to ask you…”).
The frequency of these sex-related “door-handle” queries is telling. It shows that most people are dealing with some kind of sexual concerns on a regular basis, but that many feel hesitant to bring them into the open—even with their own healthcare providers! This tight-lipped attitude toward sexual health is especially prevalent in many Western cultures, but these attitudes are not shared in all areas in the world. In China’s long medical heritage, sexual health has long been framed as a normal and important aspect of overall health, and Traditional Chinese Medicine has (literally) volumes to say about its maintenance and improvement. So, what can millennia of open inquiry into sexual wellness teach us about caring for our sexual vitality? Read on!
Types and Causes of Men’s Health Issues
Men experience a complex array of concerns related to sexual health, ranging from the psychological to the physical and often involving a mix of the two. Maintaining sexual desire between partners represents an intersection of psychosocial and physical concerns, requiring that we tend to ourselves and each other in mind, body, and spirit to achieve fulfillment of each partner’s sexual needs. Some of these issues are experienced through many phases of life, while others become increasingly common with advancing age.
The good news is that TCM offers practical tools and a several thousand year history for helping people with male reproductive organs address issues and concerns associated with sexual health. This guidance includes the use of herbal formulas and other natural tools that have been shown to be effective in addressing common male sexual health complaints.
Sexual Vitality in Traditional Chinese Medicine
Many people turn to herbs and supplements hoping for a “quick fix” for their sexual health concerns. However, as with many health issues, getting to the root of the problem for meaningful improvement requires a holistic approach to health. Chinese medicine views sexual problems like it views most afflictions, as systemic imbalances best treated with a combination of lifestyle adjustments and natural formulations chosen to restore equilibrium.
Yin and yang are the interconnected opposites that intertwine throughout Chinese philosophy. They are referenced to explain natural phenomena, human relationships, and the dynamics in between. Yin and yang loosely correlate to female and male, darkness and light, cold and warm, soft and cold, internal and external. Masculine tendencies are often considered yang while feminine tendencies are associated with yin. TCM remedies and approaches to supporting dysfunctions relating to male reproductive organs and sexual performance generally seek to restore the vitality of the yang. However, both of these aspects and their interrelationship are very fluid in nature, and thus need not line up with rigid, socially determined genders.
Many issues relating to male sexual performance and fertility are linked with qi stagnation and imbalances of the Liver, Kidney, and Heart, and the techniques and supplements recommended to address them aim to restore proper energetic flow and balance in and among these organs.
TCM Support for Sex Drive
Lack of libido (desire for sex) is a common concern that may also offer information about a person’s overall vitality. Physically, many of us worry about remaining attractive to sexual partners as we witness changes in our skin, hair, physique, body odor, and other aspects of our appearance over time. Psychologically, factors like stress, anxiety, and fatigue can get in the way of getting in the mood. Chinese medicine offers lifestyle and medicinal recommendations for finding the energy and mental space to experience the joy of desire.
MIND AND MOOD REMEDIES FOR SEXUAL HEALTH
Mental wellbeing is critical to sexual wellbeing. Stress, anxiety and depression can all contribute to low libido, difficulty obtaining and maintaining an erection, and even sperm quality.
The experience of stress often arises in situations where 1) we are overwhelmed with too much to do with too few resources to do it, and 2) we aren’t able to change the situation. While we can’t always change the situation, we can make use of tools and strategies for handling stress, such as asking for help, taking on less, and making peace with less than perfection. Herbal tools for resilience under stress include mind-calming nervines (like those found in our Tranquility Tincture) as well as balancing and resilience-building adaptogens (like you’ll find in our Sustainable Energy Tincture).
BETTER SLEEP FOR BETTER SEX
Poor sleep also impacts libido and sexual performance. There’s nothing like a bad night’s sleep to make you want to roll back over and snooze rather than snuggle! Inadequate sleep also leads to lack of focus and energy, making it hard to get into that relaxed mental space for lovemaking. Practicing good sleep hygiene (turn off that phone or computer!), establishing a sleep schedule, avoiding late-day caffeine and/or alcohol, and supporting the body with supplements such as magnesium or melatonin, can all help support healthy sleep. We also recommend our Sweet Dreams sleep support formula before bed or to help with middle-of-the-night waking.
FOODS FOR LIBIDO
A healthy diet is critical to healthy sexual energy and male fertility as well. An antioxidant-rich diet full of plants, whole grains, quality protein, and healthy fats promotes vitality by improving lean body mass, which helps lower glucose and lipid profiles. While food sources are often best, zinc, selenium, and essential fatty acid supplements have been shown to improve sperm quality and fertility outcomes. Check out our blog for many great recipes and cleanse guides to jump-start a healthy eating routine.
SMOKING, ALCOHOL, AND SEX DRIVE
As parents and healthcare practitioners, we know that wagging our fingers about the use of tobacco and nicotine products, alcohol, and excessive cannabis rarely inspires lasting change. But seriously, if you’re suffering from low libido or having difficulty conceiving, what better motivator to cut down or quit some generally unhealthy habits? Inflammation—from combustibles in the lungs or from metabolizing alcohol—causes damage to small blood vessels, from the eyes to heart to, yes, the genitals. Avoiding these toxins is as important as exercise and healthy eating for supporting fertility and desire.
TCM Support for Sexual Performance and Fertility
Concerns over the ability to achieve and maintain erection and experience ejaculation are very common, but often stigmatized. Many modern medical frameworks fail to provide thoughtful guidance and care for treating these issues. This is especially unfortunate, because both of these problems (along with semen volume and sperm quality) may also impact fertility. It is very common for clinicians to focus on women in couples experiencing infertility, but in fact, it may be impossible for couples to achieve conception without addressing male factors. For a fulfilling intimate life and/or successful reproduction, providers must address male sexual concerns openly and without shame, and Chinese medicine provides frameworks for doing so.
ERECTILE DYSFUNCTION CAUSES AND REMEDIES
Erectile Dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. In TCM, this phenomenon is referred to as “yang wilt.” It has many causes, both psychological and physical, and often a complex combination of factors are at play. The likelihood of ED does increase with age, and many of the therapies and strategies for supporting it focus on treating underlying mental and physical causes while simultaneously promoting general vitality during the aging process.
Some of the most common physical causes relate to vascular changes resulting from diabetes, medication side effects, and neural trauma from surgeries or injuries. While especially complex cases are best handled by a team of integrative practitioners, the first two scenarios above may be good candidates for addressing with holistic care.
A few important TCM factors that may contribute to ED include Liver qi stagnation and Heart and Spleen disharmony. As always, accurate pattern assessment is key, and we encourage individuals to seek the support of a Licensed Acupuncturist to obtain a useful diagnosis.
Liver qi stagnation and depression may manifest as repression or bottling up of emotions, a dissatisfaction with one’s circumstances, or difficulty letting go of resentment and frustration. Individuals who show these tendencies will have a greater likelihood of experiencing “yang wilt.” The restriction of qi’s free flow through the body will result in stagnation of Blood and, consequently, difficulty in achieving or maintaining erection. Freeing the flow of qi with traditional formulas such as Xiao Yao San (or our augmented version, Elation) may ease psycho-emotional tension in a way that allows sexual vitality to flourish.
Gui Pi Tang (aka “Ginseng and Longan Combination”) is a formula geared towards calming the mind and alleviating preoccupation, worry, and anxious thoughts while nurturing the Spleen and Heart. A common clinical scenario is an individual who is either mentally taxed by work and/or other worries who is unable to achieve an erection. In such instances, supplements for the Spleen and Heart can calm the mind and energize the individual in a way that supports sexual ability and performance.
Kidney yang deficiency is a very common diagnosis associated with aging and debility, and also chronic disease. The penis derives its warmth and reproductive capabilities from the Kidney yang, and thus, normal erectile function and fertility require a sufficient supply of Kidney yang. Yang wilt due to Kidney yang insufficiency is remedied over time with the support of standard formulas like Jin Gui Shen Qi Wan and our Penetrate the Heart Tincture, featuring yin yang huo (aka, horny goat weed).
Some of the most common evidence-based herbal and supplement therapies available include red Korean (Panax) ginseng and Ginkgo biloba which both show potential to enhance nitric oxide release to the penis support erection. L-Arginine is an amino acid that is thought to play a role in nitric oxide physiology and is commonly available as a dietary supplement.
PREMATURE EJACULATION CAUSES AND REMEDIES
Premature ejaculation, or PE, is defined as recurrent and persistent ejaculation that occurs before someone wishes, either before, during, or shortly after penetration and with minimal sexual stimulation. PE may cause considerable emotional distress and interpersonal difficulties, as it is commonly associated with inexperience, anxiety, and other psycho-emotional issues in an individual. Western medicine is limited in its offerings for men with PE, tending to emphasize behavioral awareness training and general support for anxiety. Chinese medicine, on the other hand, offers some very useful methods and tools for correcting this disorder and supporting the emotional and physiological foundations that contribute to it.
One common TCM pattern, communication breakdown between the Heart and Kidneys, may contribute to PE in cold, slender individuals, who may experience mild to moderate anxious thoughts and cold in the penis. Formulas based on the classic Cinnamon Twig with Oyster Shell and Dragon Bone recipe can be very effective for calming the mind and supporting the nervous system, helping to make genital tissue less hypersensitive to stimulation.
Another pattern that may contribute to PE is yin deficiency with hyperactivity of yang, which can present as readily obtained erections with rapid ejaculation and nocturnal emissions, as well as agitation and insomnia, weakness and aching of the low back and knees, night sweats, and sensations of heat. This syndrome is common in young men with delayed development due to poor nutrition or hereditary factors and may respond well to Zhi Bai Di Huang Wan (Rehmannia Six Formula), which includes anemarrhena and phellodendron to enrich yin and subdue yang hyperactivity.
INFERTILITY CAUSES AND REMEDIES
Many people, including clinicians, tend to associate infertility with female reproductive disharmonies. We commonly observe practitioners and couples trying to conceive without considering the obvious: sometimes, the sperm donor may be a barrier to achieving their goal.
The most common TCM diagnosis associated with male infertility include Kidney yin vacuity, kidney yang vacuity, Spleen and Kidney qi vacuity, damp-heat, blood stasis, and cold stasis. A common strategy is to supplement Kidney yin and yang with an array of herbs traditionally used in TCM and validated by modern science to optimize male fertility. Many of these herbs, such as cynomorium, curculigo, and Asian ginseng, can be found in our Conceivable ProLine formula Male Factor (more on Conceivable below).
There is an impressive amount of research available on maca and ashwagandha for supporting male fertility in humans and animals, and both have been adopted into commercial animal husbandry for optimizing semen volume and sperm quality in various livestock. Both of these herbs have similar energetics from a TCM perspective and can be useful for building vitality in both men and women. While neither herb is used in TCM, they have been readily adopted by practitioners and combine well with traditional Chinese formulas due to their widespread efficacy and safety. Both nurture yin and yang and can subdue hyperactive Liver yang. Maca is an excellent superfood and can be included in beverages or cereals on a regular basis as a powder. Ashwagandha is found in our Sustainable Energy Tincture and also makes a beneficial addition to aphrodisiac “moon milk” recipes for romance.
Our collection of TCM-based fertility support formulas, Conceivable ProLine, offers Licensed Acupuncturists and other holistic healthcare providers tools for optimizing conception abilities in both partners. We dialogue with hundreds of TCM practitioners focused on fertility and continue to learn an immense amount about this valuable discipline in integrative medicine.
Sexual Health Support Beyond Herbs
We commonly support men in optimizing their fertility with TCM and Western herbs. However, if you are having difficulty with obtaining an erection or ejaculation, or have not been able to conceive, and you’ve already been trying some of the simple lifestyle changes we’ve recommended above, it’s a good idea to seek medical advice from a trusted practitioner. Sometimes, medical conditions such as diabetes or cardiovascular disease, hormonal imbalances, or structural abnormalities in the genitourinary system, are at the root of these problems. Before you start investing in herbs, acupuncture, supplements, and other alternative treatments, we recommend a basic evaluation to rule out an underlying medical or anatomical problem.
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