Needling the penis back to life

Dear Dr G,

I am a 52-year old man who is also diabetic.

I have recently been diagnosed as having erectile dysfunction (ED).

I went to see my doctors, who told me my long-term high blood pressure, diabetes and smoking had caused my ED.

The doctor referred me to a urologist, who said my condition is not curable and will require those blue pills to “start the engine”.

I have nothing against modern medicine, but I seriously consider my blood pressure, diabetes and cholesterol problems borderline and under control.

I am also fearful that too much western medicine will be harmful to my kidneys and if I accept the treatments now, I will run out of options in the future.

The urologist prescribed me the blue pills and encouraged me to take them before sexual activity. I am reluctant to start for the above reasons.

My neighbour also has the same risk factors, smokes more than I do, and does not have any problem with his sexual health.

He suggested that I consult a traditional Chinese medicine (TCM) practitioner who is an expert in acupuncture.

I am keen on this as this is more natural and risk-free. However, I would like to put Dr G on the spot on his opinion for a more permanent solution to ED.

Can you tell us what exactly acupuncture is, and how it works?

Do you know of any study that has been published on the effect of acupuncture on ED?

If so, how were the studies done and how credible are they?

Finally, is acupuncture safe?

Hope you can enlighten me on the possibility of needling my penis back to life.

Regards,

Needling Ned

“ACUPUNCTURE” is derived from the Latin words “acus”, meaning needle, and “punctura”, meaning to puncture. This is a form of complementary alternative medicine and is one of the oldest and most substantial parts of TCM.

Gold and silver needles found in the tombs of emperors dating back to around 100 BC are the earliest evidence of the existence of acupuncture.

Life-force energy or “qi” was believed to flow in the primary organs of the body to the superficial tissues through the meridians, or pathways.

The needles are directed to the locations of these meridians, with designated sites called “Ashi points”, aiming to equilibrate the disharmony and imbalance of energy.

Classically, the insertion of thin needles in the skin at the meridian points is based on philosophy and intuition and not on a scientific basis.

A session typically entails five to 20 needles inserted and left in place for 10 to 20 minutes.

This intervention is believed to cause “micro-injuries” equivalent to heat, pressure or laser application. This in turn is believed to induce neovascularisation, the formation of new blood vessels.

In traditional acupuncture, the therapist decides which points to treat by observing and questioning the patient. Therefore, such variability often poses a challenge for scientific consistency.

In recent years, interest in acupuncture and TCM has gained enormous popularity. The excitement probably gathered momentum following endorsements from celebrities and sports personalities.

Initially believed to be effective in pain management and for musculoskeletal conditions such as headache, migraine, arthritis and allergies, acupuncture intervention has now “transgressed” into other areas of medicine such as treatment of cancer, asthma, obesity, and even drug or alcohol dependency.

How much of it is real science and how much is pseudoscience has been the subject of much scrutiny and debate.

It is also difficult, but not impossible, to design rigorous research trials for acupuncture. The main challenge is to set up an appropriate sham control group to eliminate the placebo effect.

In most research, a sham group using non-penetrating needles or needling the non-acupuncture points have been attempted to optimise clinical trials.

The most robust way to assess the efficacy of any form of intervention is a review of many high-quality prospective placebo-controlled randomised clinical trials.

Three such trials, with a total of 183 participants, exist in medical literature.

One shows the beneficial effects of actual acupuncture against sham treatment, while the other two do not.

One trial suggests that acupuncture, combined with psychological therapy, is superior to psychological therapy alone.

However, the overall methodological and reporting quality of the studies were low, and the follow-ups were short-term.

The safety of acupuncture for ED is unclear because there are too few reports on this topic.

The US politician and senator for Rhode Island, Lincoln Chaffee, once said: “Trust is built on consistency.”

Although it is encouraging to see ancient medical intervention now open to modern-day evaluation, the inconsistency of the trials makes it difficult to build up much-needed trust before accepting the treatment.

When risk factors such as smoking, dyslipidemia, diabetes and hypertension are the cause of erectile dysfunction, it does not take a genius to work out that no number of blue pills or acupuncture needles is going to solve the problem unless stringent lifestyle changes are made.

When men tempted by shortcuts of needling the penis back to life put Dr G on the spot for an opinion, he can only say: “Finding a solution to ED in acupuncture has a lower chance of success than finding the needle in the proverbial haystack.”