Is acupuncture good for erectile dysfunction? Erectile dysfunction (ED) affects a substantial proportion of UK men, with prevalence increasing with age. Whilst evidence-based treatments such as PDE5 inhibitors remain first-line therapy, some men explore complementary approaches including acupuncture. This traditional Chinese medicine technique involves inserting fine needles at specific body points, with proposed mechanisms including autonomic nervous system modulation and vascular effects. However, current evidence for acupuncture in ED is limited and of variable quality. NICE does not recommend acupuncture for ED, and it is not routinely available on the NHS for this indication. This article examines the evidence, explores how acupuncture might theoretically work, and discusses its role alongside conventional treatment.

What Is Erectile Dysfunction and How Common Is It in the UK?

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is not simply an occasional difficulty, but a recurring problem that can significantly affect quality of life, relationships, and psychological wellbeing.

ED is common in the UK. According to the National Survey of Sexual Attitudes and Lifestyles (Natsal-3), erectile difficulties affect a substantial proportion of men, with prevalence increasing with age. While occasional erectile issues are experienced by many men, persistent ED requiring treatment becomes more common in middle age and beyond. However, ED is not an inevitable consequence of ageing and can affect men of all ages.

The underlying causes of ED are diverse and often multifactorial. Vascular disease is the most common organic cause, as erections depend on adequate blood flow to the penis. Conditions such as diabetes, hypertension, high cholesterol, and obesity can all impair vascular function. Neurological disorders, hormonal imbalances (particularly low testosterone), and certain medications may also contribute. Common medication causes include some antihypertensives (particularly thiazide diuretics and beta-blockers), antidepressants (especially SSRIs/SNRIs), antipsychotics, and 5-alpha-reductase inhibitors.

Psychological factors play an important role, either as primary causes or as secondary consequences of organic ED. Performance anxiety, stress, depression, and relationship difficulties can all perpetuate erectile problems. Many men experience a combination of physical and psychological factors, making a holistic assessment essential. The MHRA-licensed treatments available in the UK primarily address the vascular component, but interest in complementary approaches such as acupuncture reflects the complex, multifactorial nature of this condition.

How Does Acupuncture Work for Erectile Dysfunction?

Acupuncture is a traditional Chinese medicine technique involving the insertion of fine needles into specific points on the body. Practitioners believe these points lie along meridians or energy channels, and that stimulating them can restore balance and promote healing. From a Western medical perspective, researchers have proposed several hypothetical physiological mechanisms that might explain acupuncture's potential effects on erectile function, though these remain largely theoretical when applied specifically to ED.

One proposed hypothesis involves the modulation of the autonomic nervous system. Erections require a complex interplay between parasympathetic (pro-erection) and sympathetic (anti-erection) nervous activity. Some research suggests acupuncture may influence this balance, potentially reducing sympathetic overactivity associated with stress and anxiety whilst enhancing parasympathetic tone. This could theoretically improve erectile response, particularly in cases where psychological factors predominate.

Another hypothesis centres on vascular effects. Animal studies have indicated that acupuncture may promote the release of nitric oxide, a crucial signalling molecule in erectile physiology. Nitric oxide causes smooth muscle relaxation in penile blood vessels, allowing increased blood flow—the same mechanism targeted by phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil. Whether acupuncture produces clinically significant nitric oxide release in humans with ED remains uncertain.

Acupuncture may also influence endogenous opioid and neurotransmitter systems, potentially affecting mood, pain perception, and stress responses. Given that psychological distress frequently accompanies or exacerbates ED, any anxiolytic or mood-enhancing effects could indirectly benefit erectile function. Additionally, the therapeutic relationship and expectation of benefit—common to many complementary therapies—may contribute to perceived improvements. It is important to note that whilst these mechanisms are biologically plausible, robust clinical evidence demonstrating meaningful therapeutic effects specifically for ED remains limited.

What Does the Research Say About Acupuncture for ED?

The evidence base for acupuncture in treating erectile dysfunction is limited and of variable quality. Systematic reviews have identified numerous small studies, predominantly from China, but methodological concerns—including inadequate blinding, small sample sizes, and publication bias—limit confidence in the findings.

Systematic reviews examining randomised controlled trials comparing acupuncture with sham acupuncture or conventional treatments for ED have found some studies reporting improvements in erectile function scores and patient-reported outcomes in the acupuncture groups. However, these reviews consistently note significant heterogeneity in acupuncture protocols, outcome measures, and study quality. Many trials lack adequate blinding, which is particularly problematic given the subjective nature of ED assessment and the potential for placebo effects.

Comparative studies with PDE5 inhibitors have generally shown conventional medications to be more effective than acupuncture alone. Studies comparing acupuncture with sildenafil typically find that whilst both groups may show improvement, the sildenafil group demonstrates significantly greater gains in validated erectile function questionnaires such as the International Index of Erectile Function (IIEF). Some studies have explored combination approaches, suggesting potential additive benefits, but these findings require replication in larger, well-designed trials.

Importantly, there is no official recommendation for acupuncture in ED from major guideline bodies. The European Association of Urology (EAU) guidelines, which inform UK practice, do not recommend acupuncture as a standard treatment for ED. Similarly, the NICE Clinical Knowledge Summary (CKS) on erectile dysfunction does not include acupuncture among recommended interventions. Most positive findings come from studies with methodological limitations, and larger, rigorous trials conducted in Western populations are notably absent.

Patients considering acupuncture should understand that whilst some men report subjective benefit—possibly through stress reduction or placebo effects—there is insufficient high-quality evidence to recommend it as a primary treatment for ED. It should not delay or replace evidence-based interventions where these are appropriate.

NHS and NICE Guidance on Acupuncture for Erectile Dysfunction

NICE does not currently recommend acupuncture as a treatment for erectile dysfunction. The NICE Clinical Knowledge Summary (CKS) on erectile dysfunction focuses on evidence-based interventions with demonstrated efficacy and safety profiles. The guidance emphasises a stepped approach beginning with lifestyle modification, psychological intervention where appropriate, and pharmacological treatment with PDE5 inhibitors as first-line therapy.

The NHS position on acupuncture for ED reflects this evidence gap. Acupuncture is not routinely available on the NHS for erectile dysfunction, as commissioning decisions are based on clinical effectiveness and cost-effectiveness evidence. The NHS does provide acupuncture for certain specific conditions where evidence is stronger—notably for prevention of tension-type headaches and migraines, and it may be considered for chronic primary pain (as per NICE guideline NG193)—but ED is not among these indications.

NICE guidance recommends that men presenting with ED should receive:

• A thorough assessment including medical, sexual, and psychosocial history

• Cardiovascular risk assessment, as ED may be an early marker of cardiovascular disease

• Physical examination and relevant investigations (such as HbA1c, fasting lipid profile, and morning total testosterone if symptoms suggest hypogonadism)

• Discussion of lifestyle factors including smoking, alcohol, exercise, and weight

• Consideration of psychological or relationship factors

• Offer of PDE5 inhibitors as first-line pharmacological treatment

The guidance acknowledges that some men may wish to explore complementary approaches but emphasises that these should not replace proven treatments. If considering acupuncture privately, patients should ensure the practitioner is appropriately qualified and registered with a recognised professional body such as the British Acupuncture Council, which is accredited by the Professional Standards Authority. Practitioners should also be licensed by the local authority. It is essential to inform your GP about any complementary therapies you are using, as this ensures coordinated care and helps identify any potential interactions with conventional treatments.

Should You Consider Acupuncture Alongside Conventional ED Treatment?

The decision to try acupuncture for ED is personal and should be made in consultation with your healthcare provider. Whilst acupuncture is generally considered safe when performed by qualified practitioners, it is important to maintain realistic expectations and prioritise evidence-based treatments.

If you are considering acupuncture, it is most appropriately viewed as a potential complementary approach rather than an alternative to conventional treatment. The strongest evidence supports PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) as first-line therapy for most men with ED. These medications are effective in approximately 70% of cases and have well-established safety profiles. However, they have important contraindications and precautions: they must never be taken with nitrates or the pulmonary hypertension drug riociguat, and caution is needed with alpha-blockers. Lifestyle modifications—including smoking cessation, reducing alcohol intake, increasing physical activity, and achieving a healthy weight—also have robust evidence supporting their benefit.

Psychological interventions should not be overlooked. Cognitive behavioural therapy (CBT) and psychosexual counselling can be highly effective, particularly when anxiety, depression, or relationship issues contribute to ED. Some men may find that acupuncture's relaxation effects complement psychological therapy, though this has not been formally studied.

Safety considerations are important. Acupuncture is generally well-tolerated, with minor side effects such as temporary soreness, minor bleeding, or bruising at needle sites. If you are taking anticoagulants or antiplatelet medications, discuss this with both your doctor and acupuncturist. Serious adverse events are rare but can include infection or pneumothorax if performed incorrectly. Always choose a practitioner registered with a recognised professional body who uses sterile, single-use needles.

When to contact your GP:

• If ED persists despite lifestyle changes

• If you experience sudden onset ED, which may indicate underlying vascular or neurological problems

• If ED is accompanied by other symptoms such as chest pain, breathlessness, or loss of morning erections

• If you have penile pain or curvature, which may suggest Peyronie's disease

• Before starting any new treatment, including acupuncture, to ensure it is safe and appropriate for you

• If conventional treatments are ineffective or cause unacceptable side effects

If you experience side effects from any treatment, including acupuncture or medications, report them through the MHRA Yellow Card Scheme.

Ultimately, the most important step is seeking professional medical assessment. ED can be an early warning sign of cardiovascular disease, diabetes, or other health conditions requiring treatment. A comprehensive approach addressing underlying causes, lifestyle factors, and psychological wellbeing—with evidence-based treatments as the foundation—offers the best chance of meaningful improvement.

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