An Analysis of Popular Online Erectile Dysfunction Supplements

Abstract

Introduction Erectile dysfunction supplements (ED-Ss) are featured on online marketplaces like Amazon.com, with dedicated pages and claims that they naturally treat ED. However, their efficacy and safety are largely unknown, limiting the ability to counsel patients regarding their use. Aim To evaluate the highest rated and most frequently reviewed ED-Ss on Amazon.com to facilitate patient counseling regarding marketing myths, ingredient profiles, and evidence for product efficacy and safety. Methods The Amazon marketplace was queried using the key term “erectile dysfunction” with default search settings and ranking items based on relevance. The top 6 ED-S products identified on September 29, 2018, were reviewed based on price, ratings, reviews, manufacturer, and ingredients. Consumer reviews were categorized using subtopics within the International Index of Erectile Function (IIEF) questionnaire to better understand ED-S efficacy and then reanalyzed following filtration of untrustworthy comments using ReviewMeta.com, a proprietary Amazon review analysis software. Outcomes Quantitative and qualitative evaluation of ED-S products sold on Amazon.com. Results The top 6 ED-Ss had an average of 2,121 ± 1,282 reviews and a mean rating of 3.92 ± 0.42 stars. A total of 21 ingredients were identified in these ED-Ss. Ginseng, horny goat weed, L-arginine, and tongkat ali were the most popular ingredients included in the analyzed products. Our literature review identified 413 studies involving the 21 identified ingredients, of which 59 (16%) involved human subjects. Among these 69 human studies, only 12 (17%) investigated supplement ingredients individually and reported improvement in ED. Analysis of top-ranked customer reviews from the first 2 pages of reviews for each supplement revealed differences in IIEF scores before and after ReviewMeta.com filtration. After filtration, we observed a 77% decrease in reviews reporting improved erection strength, an 83% decrease in reviews reporting improved ability to maintain erection, a 90% decrease in reviews reporting increased sexual satisfaction, an 88% decrease in reviews reporting increased enjoyment with intercourse, and an 89% decrease in reviews reporting increased erection confidence. Strengths & Limitations Study strengths include a novel approach to ascertaining consumers’ perceptions and satisfaction with ED-Ss and practical summary information that clinicians can provide to patients. Limitations include selection bias, the small number of supplements analyzed, and the proprietary nature of the Amazon review analysis software. Conclusions Our investigation revealed that human studies evaluating the efficacy of ED-S ingredients are limited and have yielded no definitive findings of the effects on ED. Patients considering ED-S use should receive appropriate counseling, given the prevalence of disingenuous reviews and the ready availability of Food and Drug Administration–approved drug therapies.

A review of the evolving landscape between the consumer Internet and men’s health

“…Nutraceutical supplements that claim to naturally cure ED also have ingredients such as PDE5 inhibitors (54). A recent analysis of popular ED supplements (EDS) on Amazon.com by Balasubramanian et al found that most included ingredients were exclusively studied in animal or in vitro models (55). Furthermore, the authors identified considerable differences between popular and trustworthy reviews on affiliated online EDS product pages.…”

Considerations for prescribing pharmacotherapy for the treatment of erectile dysfunction

“…One of the most rising considerations on the daily practice with ED patients is the use of herbal supplementations. Conclusively, the use of herbal supplementations in ED patients is characterized by the following facts; many products may get into the market without fulfilling strict efficacy or safety guidelines, the available data do not support the use of a special herbal product, and the comparability with PDE5i or other lines, and finally, there is a special pattern of acceptance among ED patients, especially online orders for PDE5i nonresponders, without medical advice [88,89].…”

“…Ginseng is associated with a significant improvement of erectile function in many studies [88,89]. Pinus pinaster and Lepidium meyenii are associated with positive effects, however, less powered.…”

Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review

“…The IIEF is a validated subjective score with high sensitivity and specificity for ED [1], and is used as a global standard in the clinical investigation of conventional and surgical interventions for ED [9,10]. ED can be classified as severe (IIEF score ≤7), moderate (8)(9)(10)(11), mild-to-moderate (12)(13)(14)(15)(16) and mild (17)(18)(19)(20)(21), while a IIEF score of ≥22 indicates no ED [9].…”

“…Up to 718 plant species are used in traditional medicine as aphrodisiacs, compounds that increase sexual arousal, libido, potency (erection) and/or sexual pleasure [ 13 , 19 ]. Top selling products on the market include items containing the herbs Panax ginseng (Korean ginseng), Tribulus terrestris (Tribulus), Epimedium gradiflorum (Horny goat weed), Lepidium meyenii (Maca), Ginkgo biloba (Ginkgo), Eurycoma longifolia Jack (Tongkat ali), and Pausinystalia johimbe (yohimbine), and nutraceuticals such as B complex vitamins, zinc, trace minerals, L-arginine, aspartate and dehydroepiandrosterone (DHEA) [ 6 , 15 , 20 , 21 ].…”