Human penis is a unique structure consisting of an intricate sheath that covers three cylindrical vascular and spongy tissues that contributes to the shape and structure of the organ [1]. Penis dimensions depend on the filling up of the trabeculae spaces of the penile smooth muscle fibres by blood during tumescence as well as the strength of the pelvic floor muscles when contract, help to swell up the front part of the penis. Increased relaxation of the smooth muscle fibres contributed by the release of Nitric Oxide from the nerve ends in the trabeculae and the endothelial cells can facilitate more filling of blood and enhance penile tumescence.

Ancient Middle-Eastern medicine has described the management of poor penis function due to chronic disuse by massaging the penis with fat from the camel hump. That practice probably was based on the observation that the camel hump can become rigid at most times and slumped when the camel is exhausted [1-4]. However that practice was long forgotten for obvious reasons considering that the camel hump contains reserved food storage and nothing else [1].

Now, if a similar concept is utilised, where active herbal enriched cream is used to massage the penis, maybe this might work. Such a cream should contain active ingredients, preferably plant extract known to energise tissues and the carrier cream should be penis friendly and can deliver the ingredients into the penis tissues. Studies shown that the local Malaysian herb, Eurycoma longifolia increase cGMP in the cellular level, producing smooth muscle relaxation in the corpus cavernosum, producing penis tumescence. This herb also increased levels of cAMP (cyclic adenosine monophosphate), enhancing metabolism of sugar, for energy and maintenance of tumescence through active cellular phosphorylation [2-6]. A cream containing Eurycoma longifolia extract with other herbal extracts known to be powerful antioxidants and herbal oils that protect the sensitive penis skin and facilitate delivery of bioactive ingredients to the inner tissues should be a good, men penis care cream that can maintain and enhance penile tumescence, firm enough to facilitate penetrative sex. Xgene® is the designated Eurycoma longifolia enriched male genital care cream that is expected to do just that. The Xgene^® was put to a test. The study was designed to evaluate the health benefits of massaging the cream to the glans penis in strengthening and firming up the penis.

These objectives were evaluated at every follow-up. A simple leaflet informing of a study on a men’s penis care cream that was formulated using local herb active extract of Eurycoma longifolia , to freshen and firm up male genital organ for better sex, was placed in the hospital handled by a unit catering for men’s health issues. It was also mentioned that the cream is not a form of treatment for erectile dysfunction, more a personal care and wellness product for the penis. Considering the practice of massaging, among the local population is well accepted, it was assumed that the recruitment of male participants would be easy. The Study was an open study without any specific inclusion or exclusion criteria. The study was limited to 60 participants. 60 healthy men who were keen to participate in the study were recruited. 50 men were given the non-labelled active cream and the remaining 10, non-labelled bland cream as control. The study was for two months. Each man was taught on how to apply and massage the glans penis with the cream which needs to be done for 5 minutes, twice daily. The massage includes direct massage of the glans penis with the cream and the rubbing and massaging of the base of the penis. The men filled up the SHIM (Sexual Health Inventory for Men) (Table 1).

Table 1: Erection dysfunction ED severity based on SHIM score.

Score as well as the Erection Hardness Score (Table 2). All these were repeated at two weeks, one month, 6 weeks and end of 2^nd month.

Table 2: The Erection Hardness score grades based on the scale of one to four.

All the 60 men completed the study. All 60 men responded that they never experience any skin ailment while using the cream. All the men responded they were more conscious of their penis condition ever since they use the cream. Some of the men claimed that they have better control of their erection and can hold on their erection longer than before using the cream. 4 men on the bland cream and all the 50 men on the active cream claimed that they got harder and firmer erections, scoring higher SHIM Score as well as Erection Hardness Score (Figures 1 and 2).

Figure 1: SHIM score for active vs. placebo cream.

Figure 2: Grade of erection for active vs. placebo cream.

Overall men on the bland cream showed a weak response with the bland, non-active penis care cream. Overall the penis care cream concept in men’s sexual health, benefitted men if the cream has active ingredients known to nourish tissues and nerve ends like the Eurycoma longifolia extract, in providing confidence in keeping and maintaining erection as well as in providing firmer erection with maximum grade erection Score. Some of the volunteers that were on active cream volunteered the information that they have better control of their ejaculation over a period of time while using the cream. Volunteers from the bland cream were silent about this. Men penis care cream containing the active natural ingredient in the form of Eurycoma longifolia extract provide men who have weak erection to have better grade erection and those with poor control of ejaculation, to have better control. It is suggested that through regular massaging the glans penis that contains the nerve ends; the penis is conditioned to withstand various tactile stimulation that probably activated the biofeedback mechanism to provide a conscious and firm control on the erection. It is also suggested that by rubbing and massaging the base of the penis, bulbocavernosus reflex (BCR) is initiated and thus facilitate erection [7]. However men on placebo bland cream did not experience such effects. The various active herbal ingredients content makes the difference.

The ancient concept of a penis caring cream to maintain healthy penis function and wellness can be a good way in ensuring healthy penis function, which can act as a preventive measure in erectile dysfunction, provided the cream is enriched with energy enhancing herbal extract. This Eurycoma longifolia extract enriched penis care cream is that cream. This cream, the Penis Care Cream, Xgene^®, is already available in the Malaysian market since 3 years and the common feedback that is received from the users is that the cream has created intense penis care awareness and the openness of the user to seek professional help if and when they experience disturbed function ability of their penis. The penis care cream approach for men personal genital care can function as an initial approach to ensure penis function ability before embarking on a more rigorous professional medical treatment.