When sildenafil (Viagra) was introduced fifteen years ago, it revolutionized the treatment of male sexual dysfunction. For one thing, this important but intensely personal issue came out from under the covers. Men began to approach sexual woes as medical problems, not personal failings. For another, the problem got a new and more accurate name: Erectile dysfunction (ED) replaced impotence, a term that comes from the Latin for "loss of power." Above all, sildenafil and its rivals, vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra), provide effective and safe treatment for about 70% of men with ED.
It's encouraging progress, but since some 18 million American men have ED, there are about 6 million who won't respond to the ED pills. Men who use nitrate medications for heart disease can't even try ED pills, and other men have side effects or simply do not want to use medication for ED. Other modern treatments are available, but some gents prefer to try old remedies instead of new therapies.
Acupuncture is certainly an old treatment. Some 2,500 years ago, Huang Di described its principles in his book, The Inner Classic of the Yellow Emperor. And now researchers are wondering if this ancient Asian technique can help men with ED.
Back to top
The Art and Science of Acupuncture
Acupuncture stimulates certain specific points on the body by inserting fine needles. The goal is to modify the sensation of pain and to alter bodily functions to treat or prevent various ailments.
In traditional Chinese medicine, the practitioner first inspects his patient, then smells or listens to him, and finally feels his pulse on each wrist to detect as many as 40 pulse characteristics. The practitioner treats the person by inserting fine, hair-thin needles into some of the 361 sites along the body's 59 "meridians." Typically, 6 to 10 needles are enough. According to traditional beliefs, the body's Qi (pronounced "chee"), or vital force, flows along these meridians. By stimulating specific acupoints, the practitioner aims to redirect his patient's Qi. This restores the proper balance between yin and yang, the opposite forces that determine illness and health.
The art of acupuncture depends on selecting the correct sites and inserting the needle at the proper angle and to the right depth. This is usually a fraction of an inch. The acupuncturist gently twirls the needle until he elicits a sensation of numbness, warmth or tingling; in most cases, this takes 2-30 minutes. A simple problem may only need 1 treatment. A series of 10 or more sessions is usually recommended for chronic conditions.
Although acupuncture has been known in the West for hundreds of years, it didn't attract much attention in the United States until New York Times columnist James Reston reported that acupuncture relieved his pain following emergency surgery in 1971 in Beijing.
Although some Western physicians believe in acupuncture, few accept the traditional Chinese explanations of how it works. Instead, scientists speculate that the needles stimulate the release of endorphins, the body's own morphine-like painkillers. Other theories claim the needles release neurotransmitters, chemicals that carry messages between nerve endings. But although these possibilities sound appealing to the Western scientific mind, they are by no means proven.
Back to top
Does it Work for ED?
That's a very difficult question to answer. One problem is that acupuncture is often used for subjective symptoms such as pain or for chronic conditions that can improve on their own. Even if a patient feels better after acupuncture, scientists don't know if the apparent improvement is due to the treatment, natural changes in the disease itself, or if it depends on the patient's belief in acupuncture and a desire to get well.
The only way to really find out if acupuncture works is to study it the way medications are now studied: with placebo-controlled trials. A dummy treatment is tested against the real thing, but neither the patients nor the researchers know who is getting the real treatment until the trial is over. It's easy to make an inert pill look and taste like an active medication, but it's hard to perform fake acupuncture. Most of the trials that are considered valid have compared acupuncture to sham treatments that use needles inserted in the wrong places instead of in the correct acupoints.
After evaluating hundreds of studies, a National Institutes of Health expert panel concluded that there is "clear evidence" that acupuncture is effective for three conditions:
- Pain following dental surgery
- Nausea and vomiting following surgery
- Nausea and vomiting associated with chemotherapy
Acupuncture has had a mixed and largely disappointing track record for conditions ranging from hypertension and low back pain to tennis elbow, headaches, addiction, asthma, arthritis, carpal tunnel syndrome, smoking cessation and stroke rehabilitation. Although these results have been disappointing, a 2013 study reported that acupuncture is as effective as counseling for depression. But what about ED, a physical problem that men find depressing in its own right?
A team of scientists from South Korea and the United Kingdom reviewed 15 electronic databases to find relevant acupuncture studies from around the world. The computerized search found 80 studies, but only 39 were actual clinical reports. And after careful review, only 4 studies were considered acceptable.
Two of these studies had a total of only 45 men. And neither study compared real acupuncture with sham treatment or no treatment. Both uncontrolled studies reported a benefit for acupuncture. However, one study included only men with psychologically caused ED; the other reported benefits based on claims of the treated men, even though their partners reported no improvement.
The other two studies are potentially more important because both were randomized clinical trials. A study of 21 men reported that acupuncture was better than placebo treatment, but a study of 60 men found no benefit. And the details are even more discouraging, since all the men in both trials had non-organic (psychological) ED, a condition that applies to only about 15% of American men with ED.
Back to top
Disappointing, but not Definitive Results
Despite great interest in acupuncture, research provides little evidence that it's useful for ED. Because it's generally safe, men who still want to give needles a whirl are certainly free to do so. Remember, though, that acupuncture can be time-consuming and expensive. Above all, men should not deprive themselves of helpful, scientifically validated treatments for ED. And men who don't respond to or can't use ED pills can consider alprostadil penile injections, urethral suppositories or the vacuum pump, which is an effective non-medicinal approach. Counseling can also help; even if it doesn't improve erectile function, it can improve self-esteem and encourage other forms of sexual satisfaction and intimacy.
Acupuncture for ED and other possible uses needs more study. Meanwhile, though, men who are attracted to "all natural" therapies should work on lifestyle changes that can preserve or improve erectile function. Smoking cessation, weight control, regular exercise and moderate alcohol use can help. Not incidentally, these wise choices will also protect your heart and general health -- without needles.
Back to top
Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.