A narrative review of acupuncture for sexual dysfunction: perspective of traditional Chinese medicine

Introduction

Sexual health represents an important aspect of general health, affecting sexual intimacy, mental wellbeing and physical satisfaction in life (1). A study reported that up to 50% of women and men can suffer from sexual dysfunction (SD), especially with advancing age (2). SD is a disorder of sexual behavior and sensation, often characterized by abnormal or absent sexual psychological and physiological responses. It includes male SD and female SD. In a global study, 43% of men and 49% of women reported at least one sexual problem in sexually active respondents (3). The most common issue for men was early ejaculation (24%), followed by difficulty in achieving or maintaining an erection (17%). For women, lack of sexual interest was the most prevalent problem (32%), with inability to reach orgasm as the second (25%) (3). Studies on female SD highlight the complex interactions among sexual arousal, orgasm, and sexual pain (4,5). Patients often feel embarrassed to discuss female SD, and many clinicians are unaware and unprepared to address female SD (6). Male SD includes low sexual desire, erectile dysfunction (ED), Peyronie’s disease and ejaculation and orgasm disorders, affecting men of all ages, especially those with medical comorbidities and psychological issues (7,8). In recent years, studies showed that many factors such as obstructive sleep apnoea, lack of education/knowledge are related to SD (9,10). Sexual satisfaction is crucial for both men’s and women’s quality of life, as any impairment can diminish well-being and negatively affect various life domains.

The therapeutic options to treat SD include medications, psychosexual and cognitive behavioural therapy, pelvic floor physical therapy, and surgery (11,12) with their own advantages and disadvantages. Although these treatments can be effective in carefully selected individuals, the adverse effects often cause non-adherence and attrition rates coupled by the fact that these treatments may not result in spontaneous recovery (13). Acupuncture has been widely used in many Asian countries, and several studies have confirmed its clinical efficacy and safety in premature ejaculation (PE) and ED (14,15). Previous reviews have evaluated the role of traditional Chinese medicine (TCM) therapies in SD, but there are limited reviews that focus on the acupuncture therapy (16,17). Although there has been a systematic review elucidating that acupuncture is effective and safe in the treatment of SD (18). However, this systematic review did not clarify the application of acupuncture in SD from a TCM perspective (18), and further exploration is needed on recognizing the relationship between TCM and sexual function, applying TCM theories for acupoint selection, and understanding the mechanisms of acupuncture in treating SD.

The following narrative review article aims to analyze the acupuncture therapy in SD from a TCM perspective to provide a reference for the management of SD with acupuncture. We present this article in accordance with the Narrative Review reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-24-409/rc).

Methods

The literature search was conducted in PubMed using search terms referring to a previous review (16). Case reports, letters, comments and review articles were excluded. The search was conducted from database inception to 1 April 2024. The search strategy is summarized in Table 1. Data accrued from the related studies were extracted by sample, disease, study type, age, acupoints, interventions and outcomes.

TCM’s view on acupuncture and SD

Acupuncture is an important part of TCM and encompasses many aspects of basic theory, techniques, and clinical applications. Based on the theories of “external stimulation and internal adjustment”, acupuncture offers its advantages in both functional and organic diseases and exerts a beneficial role in two-way regulation to intervene and prevent diseases, achieving the balance of yin and yang in the body (19). Acupuncture is centered on the theory of meridian points, combined with the Taoist theory of arts, mathematics, and other related theories such as the yin-yang theory and the five-element theory in ancient China civilization (20). The clinical rules of treatment, prescription and selection of acupoints are closely related to the meridian points (21). The meridian system includes twelve meridians, odd meridians and eight veins. From the perspective of TCM, all the meridians have the specific characterizations of multi-system, multi-organization interdependence and interconnection interactions (21). In ancient China, the meridians are channels for the body to run qi and blood and serves as the hubs of the body’s communication links. The meridian theory has a clear diagnostic and therapeutic significance (22).

The main objective of acupuncture is to clear and regulate the meridian based on the theory that “where the meridians pass or connect, it serves as a conduit for main treatment to reach the organs or systems of interest” (23). Approaches for localized acupoint selection and distal acupoint selection are the main treatment rules in the meridian theory. Meridian therapy focuses on recognizing the distribution of these meridian points, physiological characteristics, pathological features, and one’s symptoms to treat patients by selecting the acupoints on the meridian circulation line (23). In addition, acupuncture is used to treat diseases by selecting appropriate needles (or infrared heat) and applying suitable methods to the acupoints. On this basis, modern TCM practitioners have combined traditional acupuncture with modern physical instruments to expand the technology of electroacupuncture and other techniques, which has broadened the therapeutic scope of acupuncture.

The meridian system has extensive connections with the sexual and reproductive organs. From the perspective of TCM, sexual activity is regulated by several meridians (24). The main meridians most closely associated with sexual activity include the du meridian, ren meridian, kidney meridian of foot-shaoyin, liver meridian of foot-jueyin, spleen meridian of foot-taiyin and stomach meridian of foot-yangming (Figure 1). The circulation of these meridians all involves these sexual and reproductive organs.

Figure 1 Meridians related to sexual activities. Created in BioRender. Wang H [2024] BioRender.com/r41w176.

The principles of acupuncture in the treatment of SD are to strengthen vital qi (energy), eliminate pathogenic factors, regulate the meridians and regulate yin and yang balance. There is a gender difference in how TCM views SD. As the basic elements of TCM, qi and yang are more related to the male, while blood and yin are more related to the female. Acupuncture works by regulating these six meridians that are closely associated with SD, and then regulating the body’s micro-substances of qi, blood, yin and yang, and others to achieve a therapeutic effect. Additionally, all these six meridians also regulate sexual function from different aspects and have their own characteristics and functions (Figure 2).

Figure 2 Perspectives of traditional Chinese medicine in sexual activities. Created in BioRender. Wang H [2024] BioRender.com/q82g227.

Current clinical studies of the acupuncture therapy in SD

There were 64 articles identified in the database, and 15 clinical studies were finally included as shown in Table 2 (25-39). Of these, 1 article not only involved male SD but included female SD. Three articles are related to PE, 6 articles are related to ED and another 5 articles are related to female SD. Regarding the selection of acupoints except for Oakley et al. (36), there are not the same in the 14 studies. Interestingly, we found that many of the studies incorporated the theory of TCM discrimination, as they adapted the acupoints to each participant’s physical condition. Curran et al. (35) attributed provoked vestibulodynia to different TCM syndrome types, such as spleen deficiency, blood stasis, liver qi stagnation, etc. Approximately 10 to 20 needles were inserted at each session depending on the individual TCM diagnosis. Wang et al. (32) also showed that proximal and distal acupoints were used based on the principle of the “brain-heart-kidney-essence chamber” axis of TCM theory. Nonetheless, these acupoints were in different locations and followed different TCM theories. Our summary analysis of the acupoints in Table 2 revealed that there were 114 acupoints used for treating SD, and the ren meridian had the highest number of occurrences, followed by the liver meridian of foot-jueyin, the kidney meridian of foot-shaoyin, the stomach meridian of foot-yangming and the spleen meridian of foot-taiyin (Figure 3A). The frequency of these meridians is in line with the conclusions in Figure 1. The frequency of acupoints used also suggests that SD is associated with functional dysfunction of these 6 meridians.

Figure 3 Frequency of meridians and local and distal approaches in acupuncture. (A) Frequency statistic of the meridians to which the 114 acupoints belong to. (B) The local and distal acupuncture approaches in sexual dysfunction. Created in BioRender. Wang H [2024] BioRender.com/c64z015.

Acupuncture treatment for SD applies both local and distal approaches to select acupoints. Both approaches are related to the meridian theory of TCM. Local acupoint selection refers to the selection of acupoints in the part of the body where the disease or discomfort is located and belongs to the principle of the Yellow Emperor’s Classic of Internal Medicine (19). Distal acupoint selection requires that distal acupoints are selected at locations farther away from the lesion, in keeping with the meridian theory (40). However, distal acupoints are often used together with the local acupoint selection under the guidance of meridian theory to optimize the therapeutic action (Figure 3B). In Wang et al. (32), the authors used KI12 (Dahe) and KI3 (Taixi) in psychogenic ED, and both acupoints are from the kidney meridian of foot-shaoyin. Curran et al. used SP10 (Xuehai) and SP4 (Gongsun) in provoked vestibulodynia and both acupoints belong to the spleen meridian of foot-taiyin (35). Another study by Running et al. used ST29 (Qichong) and ST36 (Zusanli) in female SD, and both acupoints are on the stomach meridian of foot-yangming (34). Also, LR3 (Taichong) and LR12 (Jimai) were used in Yang et al. (33), and it is worth noting that the four acupoints selected by the authors in this study were all on the liver meridian of foot-jueyin. Based on the outcomes of these 15 studies, acupuncture is shown to be effective in improving SD in both men and women. Importantly, there are no documented serious adverse effects or treatment discontinuation. Adverse effects such as minor localized bleeding or pain from the needle insertion are temporary and often do not require additional interventions.

The use of acupuncture in male and female SD

The meridian theory provides a reference for the treatment of multi-system diseases such as sexual, reproductive, cardiovascular, digestive and endocrine diseases (41). While we have elucidated the applicability of meridian theory to treat SD by acupuncture, the factors affecting clinical efficacy of acupuncture therapy include the type of needle, treatment duration, and time of needle retention except for the selection of meridians or acupoints (42-44). The use of infrared heat lamp therapy to provide a synergistic effect to acupuncture is yet to be validated in a well-designed and randomized controlled study. SD is an umbrella term for a variety of different male SD symptoms including libido, erection and ejaculation disorders, while female SD includes libido, orgasm and genitopelvic pain disorders. There are different clinical efficacies for different SD due to gender differences and other psychosocial or medical factors. Previous reviews have elucidated the use of herbal medication, acupuncture, yoga, and other TCM therapies in SD, but have not specifically focused on acupuncture (16). The systematic review by Abdi et al. only analyzed the efficacy and safety of acupuncture in the treatment of SD but did not specifically analyze a single disease (18). Hence, the need to analyze the role of acupuncture in the specific disease of SD based on current research evidence.

Acupuncture in PE

PE and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men (45). A study suggested that most PE patients do not receive medication treatment (46), implying that they may opt for other alternative therapies. A meta-analysis showed that acupuncture has a significant effect on several subjective PE parameters, such as improving the feeling of control over ejaculation and distress (15). Acupuncture predominantly targets the ren meridian, the liver meridian of foot-jueyin, and kidney meridian of foot-shaoyin to treat PE, and also focuses on the utilization of proximal acupoints in the abdominal and lower limb regions from Table 2. Sahin et al. randomized 120 participants into an acupuncture group, dapoxetine 30 mg group and 60 mg group, each group had 40 subjects, with 4-week intervention, and the results showed that dapoxetine was associated with a significant increase in intravaginal ejaculatory latency time (IELT) (25). Acupuncture delayed ejaculation significantly longer than placebo; however, its effect was lower than that of dapoxetine (25). Sunay et al. divided 90 participants randomly into a paroxetine group, an acupuncture group and a sham-acupuncture group (27). Finally, increases in IELT with paroxetine, acupuncture, and placebo acupuncture were 82.7, 65.7, and 33.1 s, respectively (27). As we know, TCM believes that acupuncture therapy has immediate, cumulative and sustained effects (47). The immediate effect of acupuncture does not play an advantageous role in the treatment of PE and ED, because SD is different from pain or some acute diseases, and it is difficult to achieve an immediate effect with only one session of acupuncture treatment like phosphodiesterase-5 inhibitor or selective serotonin reuptake inhibitor (48). However, the cumulative and sustained effects of acupuncture should not be ignored. There is doubt whether the cumulative and sustained effects last several weeks after treatment. As the authors mentioned, the most important limitation of the study was the lack of follow-up (27).

The mechanism of acupuncture in PE is unclear. Corona et al. showed that high serum testosterone levels were associated with the development of PE, while patients with low serum testosterone were more likely to have delayed ejaculation (49). According to the findings of Lu et al., acupuncture reduced serum testosterone levels in patients with PE (26). Combined with the limited evidence, it is uncertain whether acupuncture treats PE by modulating sex hormone levels or through another modality. The 5-hydroxy tryptamine is crucial in the central nervous system, widely distributed in the hypothalamus, brainstem, and spinal cord, and involved in regulating the ejaculatory process (50). Wang et al. demonstrated that electroacupuncture at ST36 (Zusanli) can regulate 5-hydroxy tryptamine concentration in hypothalamus and serum (51). Since some studies have explored the mechanism of PE in terms of brain activity (52,53), there is emerging evidence that acupuncture plays a role in sexual activity by modulating the function of the brain activity, spinal cord and peripheral nervous system (33).

Acupuncture in ED

ED is a common SD, affecting men of all ages and can result in considerable distress and poorer quality of life (54,55). Furthermore, ED is associated with a wide variety of underlying conditions such as psychosomatic disorders, diabetes and cardiovascular co-morbidities (56). All six studies of acupuncture for ED included in Table 2 showed that ED patients can benefit from acupuncture (28-33). From a previous review, the acupoints used to treat ED focus on the ren meridian and the kidney meridian of foot-shaoyin and follow the principle of combining proximal and distal acupoints (43). However, there is insufficient evidence to define the optimal retention time and treatment duration of acupuncture (43). Guidelines for the treatment of ED in TCM recommend that a course of acupuncture should be provided no less than 4 weeks of treatment and that longer treatment times are often needed for ED patients with organic cause (57). Although systematic reviews have demonstrated the efficacy of acupuncture in the treatment of ED, the exact underlying aetiology of ED was not defined in these studies (58,59). In Table 2, participants in five studies were psychogenic ED, and only the study by Kho et al. included participants with organic ED (30). Kho et al. included 13 participants with ED with four patients who had drug-induced ED, diabetic ED, hypertensive ED, and arteriogenic ED as demonstrated by penile duplex ultrasound (30). After 4 weeks of acupuncture treatment, erectile function improved only in one participant with drug-induced ED (30). As a complementary and alternative therapy, the exact efficacy of acupuncture in organic ED remains challenging.

Currently, the mechanism for acupuncture in psychogenic ED may be related to regulating the hypothalamus, reproductive hormones and local neuronal actions (43). Also, Yang et al. demonstrated that stimulating BL23 (Shenshu) and SP6 (Sanyinjiao) improves erectile function in diabetic ED rats and significantly increases their total nitric oxide synthase and cyclic guanosine monophosphate levels in penis (60), suggesting that acupuncture may also regulate the nitric oxide/cyclic guanosine monophosphate pathway in ED rats. Acupuncture not only improves erectile function but also improves symptoms of anxiety and depression (32,33). From the view of TCM, the improvement of psychological disorders reflects the characteristics of holistic treatment, which is not limited to erectile function alone but extends to therapeutic effects on other symptoms that often accompany ED patients. This TCM view may have a good counterpart in the Western point of view that SD can induce psychological disorders, and these psychological disorders may worsen preexisting SD in turn (61). The Yellow Emperor’s Classic of Internal Medicine emphasizes the role of acupuncture in regulating the “spirit”, which includes a person’s mental state, consciousness, emotions, and thinking activities (19). In terms of the improvement of psychological disorders by acupuncture, it may also be related to the regulation of brain activity, which was also confirmed by Yang et al. (33).

Acupuncture in female SD

Female SD refers to the dysfunction of one or more stages of the female sexual response cycle or the presence of pain related to sexual intercourse (62). It mainly included hypoactive sexual desire disorder, sexual arousal disorder, orgasmic disorder and sexual pain disorders (63). According to TCM, female SD is mostly caused by a deficiency of the kidney, which involves the dysfunction of the ren meridian, kidney meridian of foot-shaoyin, liver meridian of foot-jueyin, and spleen meridian of foot-taiyin. Acupoints in Table 2 are also from these meridians. A previous meta-analysis showed acupuncture may treat female SD by improving the Female Sexual Function Index (FSFI) total score, sexual desire and sexual arousal (64). This meta-analysis missed two important pilot studies, which we have included in this review (35,36). Additionally, other concerns in this meta-analysis have been elucidated by other authors (65). Running et al. reported that acupuncture significantly improved sexual desire and reduced psychological symptoms (34). Curran et al. revealed women had a significant decrease in pain with manual genital stimulation and helplessness on the pain-associated cognitions after 5-week acupuncture treatment (35). Both Oakley et al. and Zhang et al. showed that acupuncture not only increased the total FSFI score, but significantly improved their desire domain, arousal, lubrication and orgasm (36,37). Similarly, Oakley et al. also reported the active effect of acupuncture on the Female Sexual Distress Scale, General Anxiety-Disorder-7 and Prime Health Questionnaire-9 (36). However, another study by Schlaeger et al. included 18 women who were troubled by vulvodynia and showed acupuncture did not significantly increase sexual desire, sexual arousal, lubrication, ability to orgasm or sexual satisfaction (38). We speculate that the main purpose of this study was to treat pain, not to increase sexual desire, sexual arousal, or lubrication and the acupoints were around the genitals and had effects on pain and spasms of genitals (38). Simply increasing the physical response without addressing the underlying women’s emotions, stress, and other psychological factors will not positively influence sexual satisfaction. Studies showed that improvements in sexual symptoms alone may not translate into increased sexual satisfaction, as the two sexual domains appear to be out of sync in some women (66,67).

TCM believes that female SD is related to the imbalance of yin and yang, especially the kidney’s yin and yang. Kidney yin is a fluid substance that has the effect of lubricating the vagina, while kidney yang has the effect of agitating and promoting sexual desire. Some studies have shown that kidney yang is related to testosterone levels (68,69), and testosterone plays a key role in female sexual behaviour, especially libido (70). It is still unknown whether acupuncture improves testosterone levels in patients with female SD. As far as we know, female SD is also related to psychosocial, endocrine, neurogenic, and vascular-muscular factors except the sex hormone (71,72). Further studies to explore the mechanisms by which acupuncture improves female SD are required.

Limitation

This review focuses on exploring the role of acupuncture in SD from TCM views, aiming to offer insight on the role of acupuncture for SD based on TCM theories. We acknowledge our limitations due to the small sample size and low quality of evidence from available literature.

To date, there are still many concerns regarding acupuncture for SD due to the following reasons:

• There are relatively few studies on the quantitative effect of acupuncture sessions, duration of needle retention and the comparison of the clinical efficacy of different types of acupuncture;
• Acupuncture for SD is relatively understudied in terms of its actual mechanism and the optimal acupoints with a lack of large-sample, multicenter, high-quality clinical studies;
• There is a lack of standardized guideline on acupuncture treatment in SD.

Conclusions

To the best of our knowledge, this is the first study to critically evaluate the clinical effects of acupuncture on SD from the perspective of TCM. Acupuncture for SD is mainly based on the meridian theory, and the acupoints of ren meridian, liver meridian of foot-jueyin, kidney meridian of foot-shaoyin, stomach meridian of foot-yangming, spleen meridian of foot-taiyin, and du meridian are critical to effective treatment based on a combination of localized and distal acupoints. While acupuncture therapy has its characteristics in treating PE, ED, and female SD, future studies on acupuncture for these diseases need to be guided by TCM theory to select acupoints and meridians, and conduct large-sample, multi-center randomized controlled clinical trials. Additionally, as the mechanisms of acupuncture for SD remain unclear, more attention to basic research in this field is also needed to elucidate the relevant mechanism.

Acknowledgments

Funding: This research was supported by the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences (No. CI2021A02203) and State Administration of Traditional Chinese Medicine High-level Key Discipline Construction Project (No. zyyzdxk-2023238).

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-24-409/rc

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-24-409/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-409/coif). E.C. serves as an unpaid Associate Editor-in-Chief of Translational Andrology and Urology from August 2024 to July 2026. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Bond KT, Radix AE. Sexual Health and Well-Being: A Framework to Guide Care. Med Clin North Am 2024;108:241-55. [Crossref] [PubMed]
2. Lewis RW, Fugl-Meyer KS, Bosch R, et al. Epidemiology/risk factors of sexual dysfunction. J Sex Med 2004;1:35-9. [Crossref] [PubMed]
3. Moreira ED Jr, Brock G, Glasser DB, et al. Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors. Int J Clin Pract 2005;59:6-16. [Crossref] [PubMed]
4. Gong S, Yim S, Kabarriti A. Top 50 most cited articles about female sexual dysfunction: a bibliometric analysis. Sex Med Rev 2024;12:270-8. [Crossref] [PubMed]
5. Erdős C, Kelemen O, Pócs D, et al. Female Sexual Dysfunction in Association with Sexual History, Sexual Abuse and Satisfaction: A Cross-Sectional Study in Hungary. J Clin Med 2023;12:1112. [Crossref] [PubMed]
6. Luo L, Huang J, Li H. Barriers to sexual health-seeking behaviors for Chinese women. Arch Womens Ment Health 2023;26:581-8. [Crossref] [PubMed]
7. Rowland DL, Kӧvi Z, Hevesi K. Age-related differences in the prevalence of premature ejaculation: taking a second and more detailed look. Sex Med 2024;12:qfae057. [Crossref] [PubMed]
8. Demirci A, Hızlı F, Hamurcu HD, et al. Erectile dysfunction, anxiety, perceived stress, and insomnia are more common among acquired premature ejaculation patients compared to other premature ejaculation syndromes. Andrology 2023;11:425-32. [Crossref] [PubMed]
9. Romano L, Zagari RM, Arcaniolo D, et al. Sexual dysfunction in gastroenterological patients: Do gastroenterologists care enough? A nationwide survey from the Italian Society of Gastroenterology (SIGE). Dig Liver Dis 2022;54:1494-501. [Crossref] [PubMed]
10. Cantone E, Massanova M, Crocetto F, et al. The relationship between obstructive sleep apnoea and erectile dysfunction: An underdiagnosed link? A prospective cross-sectional study. Andrologia 2022;54:e14504. [Crossref] [PubMed]
11. Nappi RE, Tiranini L, Martini E, et al. Medical Treatment of Female Sexual Dysfunction. Urol Clin North Am 2022;49:299-307. [Crossref] [PubMed]
12. Salonia A, Bettocchi C, Boeri L, et al. European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction. Eur Urol 2021;80:333-57. [Crossref] [PubMed]
13. Chung E, Cartmill R. Evaluation of Long-Term Clinical Outcomes and Patient Satisfaction Rate Following Low Intensity Shock Wave Therapy in Men With Erectile Dysfunction: A Minimum 5-Year Follow-Up on a Prospective Open-Label Single-Arm Clinical Study. Sex Med 2021;9:100384. [Crossref] [PubMed]
14. Zhu M, Quan F, Xue K, et al. Acupuncture for erectile dysfunction: a randomized controlled trial. Zhongguo Zhen Jiu 2024;44:418-22. [Crossref] [PubMed]
15. Zhang H, Colonnello E, Sansone A, et al. Acupuncture for premature ejaculation: a systematic review and meta-analysis. Sex Med 2023;11:qfad034. [Crossref] [PubMed]
16. Chubak B, Doctor A. Traditional Chinese Medicine for Sexual Dysfunction: Review of the Evidence. Sex Med Rev 2018;6:410-8. [Crossref] [PubMed]
17. Aung HH, Dey L, Rand V, et al. Alternative therapies for male and female sexual dysfunction. Am J Chin Med 2004;32:161-73. [Crossref] [PubMed]
18. Abdi F, Alimoradi Z, Roozbeh N, et al. Does acupuncture improve sexual dysfunction? A systematic review. J Complement Integr Med 2023;20:1-16. [Crossref] [PubMed]
19. Zhuang Y, Xing JJ, Li J, et al. History of acupuncture research. Int Rev Neurobiol 2013;111:1-23. [Crossref] [PubMed]
20. Ma Q, Wang J. Fascia and defensive qi: construction of body view in classical acupuncture theory. Zhongguo Zhen Jiu 2023;43:871-5. [Crossref] [PubMed]
21. Chang S. The meridian system and mechanism of acupuncture-a comparative review. Part 1: the meridian system. Taiwan J Obstet Gynecol 2012;51:506-14. [Crossref] [PubMed]
22. Wang GJ, Ayati MH, Zhang WB. Meridian studies in China: a systematic review. J Acupunct Meridian Stud 2010;3:1-9. [Crossref] [PubMed]
23. Zhou W, Benharash P. Effects and mechanisms of acupuncture based on the principle of meridians. J Acupunct Meridian Stud 2014;7:190-3. [Crossref] [PubMed]
24. Xia L, Xia Y. Clinical research and the effect mechanism on premature ovarian failure treated with acupuncture in recent 20 years. Zhongguo Zhen Jiu 2018;38:5653-70. [Crossref] [PubMed]
25. Sahin S, Bicer M, Yenice MG, et al. A Prospective Randomized Controlled Study to Compare Acupuncture and Dapoxetine for the Treatment of Premature Ejaculation. Urol Int 2016;97:104-11. [Crossref] [PubMed]
26. Lu X, Han H, Zhang Z, et al. Study on the Efficacy of Electric Acupuncture in the Treatment of Premature Ejaculation Based on Testosterone Level. J Healthc Eng 2022;2022:8331688. [Crossref] [PubMed]
27. Sunay D, Sunay M, Aydoğmuş Y, et al. Acupuncture versus paroxetine for the treatment of premature ejaculation: a randomized, placebo-controlled clinical trial. Eur Urol 2011;59:765-71. [Crossref] [PubMed]
28. Engelhardt PF, Daha LK, Zils T, et al. Acupuncture in the treatment of psychogenic erectile dysfunction: first results of a prospective randomized placebo-controlled study. Int J Impot Res 2003;15:343-6. [Crossref] [PubMed]
29. Aydin S, Ercan M, Caşkurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997;31:271-4. [Crossref] [PubMed]
30. Kho HG, Sweep CG, Chen X, et al. The use of acupuncture in the treatment of erectile dysfunction. Int J Impot Res 1999;11:41-6. [Crossref] [PubMed]
31. Yaman LS, Kiliç S, Sarica K, et al. The place of acupuncture in the management of psychogenic impotence. Eur Urol 1994;26:52-5. [Crossref] [PubMed]
32. Wang H, Lei X, Ma D, et al. Efficacy of acupuncture for psychogenic erectile dysfunction: a randomized, sham-controlled trial. Basic Clin Androl 2023;33:40. [Crossref] [PubMed]
33. Yang Y, Qu L, Mu L, et al. Electroacupuncture for psychogenic erectile dysfunction: A resting-state functional magnetic resonance imaging study exploring the alteration of fractional amplitude of low frequency fluctuation. Front Hum Neurosci 2023;17:1116202. [Crossref] [PubMed]
34. Running A, Smith-Gagen J, Wellhoner M, et al. Acupuncture and Female Sexual Dysfunction: A Time-Series Study of Symptom Relief. Med Acupunct 2012;24:249-55.
35. Curran S, Brotto LA, Fisher H, et al. The ACTIV study: acupuncture treatment in provoked vestibulodynia. J Sex Med 2010;7:981-95. [Crossref] [PubMed]
36. Oakley SH, Walther-Liu J, Crisp CC, et al. Acupuncture in Premenopausal Women With Hypoactive Sexual Desire Disorder: A Prospective Cohort Pilot Study. Sex Med 2016;4:e176-81. [Crossref] [PubMed]
37. Zhang JT, Ma L, Gong X, et al. Clinical Study on the Use of Acupuncture for the Treatment of Female Sexual Dysfunction: A Pilot Study. Sex Med 2022;10:100541. [Crossref] [PubMed]
38. Schlaeger JM, Xu N, Mejta CL, et al. Acupuncture for the treatment of vulvodynia: a randomized wait-list controlled pilot study. J Sex Med 2015;12:1019-27. [Crossref] [PubMed]
39. Khamba B, Aucoin M, Lytle M, et al. Efficacy of acupuncture treatment of sexual dysfunction secondary to antidepressants. J Altern Complement Med 2013;19:862-9. [Crossref] [PubMed]
40. Li F, He T, Xu Q, et al. What is the Acupoint? A preliminary review of Acupoints. Pain Med 2015;16:1905-15. [Crossref] [PubMed]
41. Yang MN, Han JX. Review and analysis on the meridian research of China over the past sixty years. Chin J Integr Med 2015;21:394-400. [Crossref] [PubMed]
42. Wang H, Zhang J, Ma D, et al. The Role of Acupuncture and Its Related Mechanism in Treating Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Int J Gen Med 2023;16:4039-50. [Crossref] [PubMed]
43. Wang H, Zhao M, Zhang J, et al. The Efficacy of Acupuncture on Patients with Erectile Dysfunction: A Review. Evid Based Complement Alternat Med 2022;2022:4807271. [Crossref] [PubMed]
44. Wang H, Lei X. Acupuncture for Women with Overactive Bladder: Perspective of Traditional Chinese Medicine and Related Mechanism. Int J Gen Med 2023;16:1137-48. [Crossref] [PubMed]
45. Colonnello E, Ciocca G, Limoncin E, et al. Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity. Nat Rev Urol 2021;18:115-27. [Crossref] [PubMed]
46. Zucker I, Nackeeran S, Kulkarni N, et al. Majority of men with premature ejaculation do not receive pharmacotherapy. Int J Impot Res 2023;35:544-7. [Crossref] [PubMed]
47. Wang H, Guo J, Zhang Y, et al. Efficacy of Scalp Acupuncture with the Long-Stay Method on Motor Dysfunction in Patients with Acute Ischemic Stroke: A Randomized Controlled Trial. Neuropsychiatr Dis Treat 2023;19:1273-83. [Crossref] [PubMed]
48. Colonnello E, Sansone A, Jannini EA. Acupuncture for male sexual dysfunction in the light of the new sexual traditional Chinese medicine. J Sex Med 2023;20:1228-9. [Crossref] [PubMed]
49. Corona G, Jannini EA, Mannucci E, et al. Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med 2008;5:1991-8. [Crossref] [PubMed]
50. Guo Y, Wang Y, Wang X, et al. Association Between Changes in Serum 5-Hydroxy-Tryptamine Concentrations and Improvement in Clinical Symptoms in Primary Premature Ejaculation with Paroxetine Treatment. Med Sci Monit 2015;21:2521-7. [Crossref] [PubMed]
51. Wang XY, Wu FD. Effect of Electroacupuncture at Zusanli on 5-HT of Normal Rats. Journal of Clinical Acupuncture and Moxibustion. 2012;28:51-52.
52. Chen J, Yang J, Huang X, et al. Brain Functional Biomarkers Distinguishing Premature Ejaculation From Anejaculation by ALFF: A Resting-State fMRI Study. J Sex Med 2020;17:2331-40. [Crossref] [PubMed]
53. Lu J, Yuan L, Jin J, et al. Brain Cortical Complexity and Subcortical Morphometrics in Lifelong Premature Ejaculation. Front Hum Neurosci 2020;14:283. [Crossref] [PubMed]
54. Chung E. A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction. Med Sci (Basel) 2019;7:91. [Crossref] [PubMed]
55. Chung E, Bailey W, Wang J A. Prospective, Randomized, Double-Blinded, Clinical Trial Using a Second-Generation Duolith SD1 Low-Intensity Shockwave Machine in Males with Vascular Erectile Dysfunction. World J Mens Health 2023;41:94-100. [Crossref] [PubMed]
56. Jannini EA, Droupy S. Needs and Expectations of Patients with Erectile Dysfunction: An Update on Pharmacological Innovations in Phosphodiesterase Type 5 Inhibition with Focus on Sildenafil. Sex Med 2019;7:1-10. [Crossref] [PubMed]
57. Yu W, Wang H. Multiple disciplinary teamwork guidelines of integrated traditional Chinese medicine & western medicine for the erectile dysfunction (2022 edition). Chin J Androl 2022;36:3-9.
58. Cui X, Zhou J, Qin Z, et al. Acupuncture for Erectile Dysfunction: A Systematic Review. Biomed Res Int 2016;2016:2171923. [Crossref] [PubMed]
59. Lai BY, Cao HJ, Yang GY, et al. Acupuncture for Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis. World J Mens Health 2019;37:322-38. [Crossref] [PubMed]
60. Yang YK, Rong HB, Chen HP, et al. Effects of moxibustion on erectile function and NO-cGMP pathway in diabetic rats with erectile dysfunction. Zhongguo Zhen Jiu 2007;27:353-6.
61. Jannini EA, McCabe MP, Salonia A, et al. Organic vs. psychogenic? The Manichean diagnosis in sexual medicine. J Sex Med 2010;7:1726-33. [Crossref] [PubMed]
62. Jannini EA, Burri A, Jern P, et al. Genetics of Human Sexual Behavior: Where We Are, Where We Are Going. Sex Med Rev 2015;3:65-77. [Crossref] [PubMed]
63. Female Sexual Dysfunction. ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists, Number 213. Obstet Gynecol 2019;134:e1-e18. [Crossref] [PubMed]
64. Ning S, Liu S, Chen X, et al. Acupuncture modification treatment for female sexual dysfunction: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023;291:29-33. [Crossref] [PubMed]
65. Colonnello E, Zhang H, Liu S, et al. Letter to the editor on "Acupuncture modification treatment for female sexual dysfunction: Ameta-analysis". Eur J Obstet Gynecol Reprod Biol 2024;296:376-7. [Crossref] [PubMed]
66. Ferenidou F, Kapoteli V, Moisidis K, et al. Presence of a sexual problem may not affect women's satisfaction from their sexual function. J Sex Med 2008;5:631-9. [Crossref] [PubMed]
67. Bancroft J, Loftus J, Long JS. Distress about sex: a national survey of women in heterosexual relationships. Arch Sex Behav 2003;32:193-208. [Crossref] [PubMed]
68. Yang J, Wang Y, Bao Y, et al. The total flavones from Semen cuscutae reverse the reduction of testosterone level and the expression of androgen receptor gene in kidney-yang deficient mice. J Ethnopharmacol 2008;119:166-71. [Crossref] [PubMed]
69. Yang S, Xu X, Xu H, et al. Purification, characterization and biological effect of reversing the kidney-yang deficiency of polysaccharides from semen cuscutae. Carbohydr Polym 2017;175:249-56. [Crossref] [PubMed]
70. Khera M. Testosterone Therapy for Female Sexual Dysfunction. Sex Med Rev 2015;3:137-44. [Crossref] [PubMed]
71. Jannini EA, Buisson O, Rubio-Casillas A. Beyond the G-spot: clitourethrovaginal complex anatomy in female orgasm. Nat Rev Urol 2014;11:531-8. [Crossref] [PubMed]
72. Sood R, Kuhle CL, Thielen JM, et al. Association of mindfulness with female sexual dysfunction. Maturitas 2022;161:27-32. [Crossref] [PubMed]