Original Paper
Curr Urol 2007;1:39-41 Received: February 16, 2007
DOI:10.1159/000106527
Acupuncture Treatment of Psychogenic Erectile
Dysfunction: A Four-Year Follow-Up Study
Lukas K. Dahaa Dara Lazara Paul F. Engelhardtb Reiner Simaka Heinz Pflügera
a
Department of Urology and Ludwig Boltzmann Institute of Urology and Andrology, Municipal Hospital Hietz-
ing, Vienna; bDepartment of Urology and Andrology, Thermenklinikum Baden, Austria
Key Words
Impotence · Acupuncture
Abstract
Background: The aim of the study was to assess the long-
term effects of acupuncture treatment in patients suffer-
ing from psychogenic erectile dysfunction (ED). Patients
and Methods: Twenty patients with psychogenic ED who
underwent acupuncture treatment between 1999 and
2001 were invited to an after-care interview with the items
International Index of Erectile Function (IIEF) 15 Score, influ-
ence of acupuncture on quality of life, effect and duration
of acupuncture treatment on erectile status and willingness
to repeat the treatment. Results: Fifteen patients accepted
our invitation. Comparison of the IIEF 15 Score shortly after
treatment with the Score in 2005 showed no statistically
relevant difference (P = 0.608). Sixty-seven percent (n =
10) of the after-care patients reported an improvement in
their quality of life and 53% (n = 8) would repeat this acu-
puncture treatment. Conclusions: The results are a first
indication that long-term effects could be reached through
acupuncture treatment.
Copyright © 2007 S. Karger AG, Basel
Introduction
A combination of nerval, hormonal and vascular
interaction is decisive for a sufficient erection [1]. Erec-
© 2007 S. Karger AG, Basel
1015-9770/07/0001-0039$23.50/0
Fax +41 61 306 12 34
E-Mail karger@karger.ch Accessible online at:
www.karger.com www.karger.com/cur
Accepted: May 17, 2007
Published online: September 1, 2007
tile dysfunction (ED) shows a prevalence ranging from
2% among men below 40 years up to 86% among men
aged 80 years or older [2, 3]. Sympathetic over-activity
is mainly held responsible for psychogenic ED. Organic
problems are observed in up to 90% of the impotent pa-
tients [4].
Over the past decades, acupuncture treatment, a
part of Traditional Chinese Medicine, has found its way
into Western Medicine. In urology, acupuncture is used
for the treatment of renal colic, incontinence, impotence
and infertility, where positive results were achieved
[5-17]. In a previous prospective, placebo-controlled
study, it was shown that there was an improvement
through acupuncture treatment in 68% of patients suf-
fering from psychogenic ED [18]. So far, however, there
have been no long-term follow-up studies regarding the
success and long-term effects of acupuncture treatment
in patients with psychogenic ED. The aim of the study
was to evaluate possible long-term effects of acupunc-
ture treatment in patients with ED.
Patients and Methods
The study was designed as an after-care interview, 4 years
after a placebo controlled cross over acupuncture trial. All of the
20 patients, who took part in our initial study from 1999 to 2001,
were invited to a control visit in 2005. This second interview
included the following questions: influence of acupuncture on
quality of life, effect and duration of acupuncture on erectile sta-
tus, and willingness to repeat the treatment.
Lukas K. Daha
Department of Urology
Hospital Hietzing, Wolkersbergenstrasse 1
A-1130 Vienna (Austria)
Tel.+ 43 1 80110 2279, Fax + 43 1 80110 2689, E-Mail lukas.daha@wienkav.at
 The present erectile status was assessed through the Inter-
national Index of Erectile Function (IIEF) 15 Score [19] and
compared with the results of 4 years previously [18].
The statistic analysis between the two IIEF 15 Scores,
shortly after treatment, and in 2005 was carried out by using the
Wilcoxon Signed Rank test. A p value of < 0.05 was considered
statistically significant. All analyses and interviews were carried
out by the author (LKD).
Results
Fifteen (75%) out of 20 patients accepted the invita-
tion. The mean observation period was 4.5 years (4.2-5
years). The median IIEF 15 Score was 43.7 before the
treatment, 62 shortly after the treatment and 56 in 2005
(fig. 1). Sixty-seven percent (n = 10) of the after-care
patients reported a quality of life improvement after the
treatment and 53% (n = 8) said they would repeat the
treatment. More than 4 years after acupuncture therapy,
47% (n = 7) of the patients did not need any further
treatment and considered themselves cured. The IIEF
15 Score of these patients was 66 after therapy 4 years
previously, compared to 65 in 2005. Forty-seven percent
(n = 7) of the patients informed us of the intake of phos-
phatiesterase (PDE) 5 inhibitors and 7% of the patients
(n = 1) is undergoing psychotherapeutic treatment. None
of the patients did pelvic floor exercises. The IIEF 15
Score of the 5 patients (33%) who did not show any
improvement 4 years previously went down from 51
shortly after the treatment to 39 at present.
When comparing the two scores after treatment no
statistical difference can be seen (p = 0.608).
Discussion
This is the first study to show the long-term effect
of acupuncture in patients with psychogenic ED. In a
placebo-controlled prospective cross over study be-
tween 1999 and 2001, a positive effect of acupuncture
was shown in 75% of patients with psychogenic ED
[18]. The present study confirms that for almost half of
the previously successfully treated patients, the positive
trend continued and no further treatment was necessary.
According to the theories of Traditional Chinese
Medicine, all disorders and diseases can be related to an
imbalance in vital energy. Acupuncture acts to keep the
normal flow of this energy unblocked [20, 21]. The pos-
itive effects of acupuncture in stress therapy are mainly
contributed to the strengthening of the parasympathetic
nervous system [22, 23]. This would also explain why
75% of the patients initially responded to this therapy.
In our placebo-controlled study we used the fol-
lowing standardized points: N6, N27, KG4, KG6, LG4,
MP6, and B23. A lasting re-balancing of the body en-
ergy was achieved in 47% of the patients and no further
treatment was necessary. A further 47% of the patients
occasionally use PDE 5 inhibitors. These PDE 5 inhibi-
tors have revolutionized the treatment of psychogenic
ED due to their quick effect and easy access. In contrast
to that, acupuncture treatment for ED is time consum-
ing and has therefore been on the decline over the past
years. However, as there are no side effects known for
acupuncture, it is also a good alternative for patients for
whom PDE 5 inhibitors are contra-indicated.
Treatment for psychogenic ED ranges from psycho-
therapy to systematic treatment with PDE 5 inhibitors.
)LJ,,()VFRUHEHIRUHDLPPHGLDWHO\DIWHUEDQGPRUHWKDQIRXU\HDUVDIWHUWKHUDS\F 

In our previous pilot study, we were able to achieve a
complete remission in almost 70% of patients and a
significant improvement in a further 20% [18]. Only
10% of the patients showed no improvement. Four years
later, almost half of the 15 patients with after-care had
no complaints regarding their erectile functions. Two
thirds of the patients reported a continuing improvement
in their quality of life and more than half of the patients
would undergo such a treatment again.
With this study we were able to show the positive
trend of an acupuncture treatment. The significance is
given, but due to the small number of patients of only
little statistical power.
With the data from our first placebo-controlled
             a         D
b E   c    F 

study, we were able to show the positive effect of acu-
 puncture in 70% of patients with psychogenic ED. A fol-
 low-up study showed a lasting positive effect in nearly
Fig. 1. IIEF 15 Score before (a), immediately after (b) and more half of the cases. Almost 70% of the after-care patients
than 4 years after therapy (c).

40 Curr Urol 2007;1:39-41 Daha/Lazar/Engelhardt/Simak/Pflüger

reported a continuing improvement in their quality of
life. From our point of view, acupuncture could be con-
sidered a good therapeutic alternative to conventional
References
1 Aboseif SR, Lue TF: Hemodynamics of 9 Yaman LS, Kilic S, Sarica K, Bayar M,
penile erections. Urol Clin North Am 1998;
15:1-7.
2 Prins J, Blanker MH, Bohnen Am, Thomas
S, Bosch JL: Prevalence of erectile dysfunc- 10
tion: a systemic review of populationbased
studies. Int J Impot Res 2002;14:422-432.
3 Feldmann HA , Goldstein I, Hatzichristou
DG, Krane RJ, McKinlay JB : Impotence 11
and its medical and psychological correlates:
results of the Massachusetts Male Aging
Study. J Urol 1994;151:54-59.
4 Golijanin D, Singer E, Davis R, Bhatt S,
Seftel A, Dogra V: Doppler evaluation of
erectile dysfunction - Part 1. Int J Impot Res 12
2007;19:37-42.
5 Lin S N, et al.: Acupuncture and urethral
function: experimental study (abstract). J
Urol 1984;131:382. 13
6 Mc Gurire EJ, Shi-Chun Z, Horwinsky ER:
Treatment of motor sensory detrusor insta-
bility by electrical stimulation. J Urol 1983; 14
129:78-81.
7 Meiquan, Z: Percussopunctator treatment of
enuresis on the basis of differential typing
of the symptoms. J Trad Chin Med 1986;6: 15
171-173.
8 Crimmel AS, Conner C S, Monga M, With-
ered Yang: A review of traditional chinese 16
medical treatment of male infertility and
erectile dysfunction. J Andtrol 2001;22:
173-182.
Acupuncture Treatment of Psychogenic ED
treatment with good long-term results. Further research
with a larger study population is needed to prove this
hypothesis.
Saygin B: The place of acupuncture in the
ma­n­a­ge­ment of psychogenic impotence. Eur
Urol 1994;26:52-55.
Kho HG, Sweep CGJ, Rabsztyn PRI,
Meulemann EJH: The use of acuuncture in
the treatment of erectile dysfunction. Int J
Impo Res 1999;11:41-46.
Aydin S, Ercan M, Caskurlu T, Tasci AI,
Karaman I, Odabas O, Yilmaz Y, Agargun
MY, Kara H, Sevin G: Acupuncture and
hypnotic suggestions in the treatment of
non-organic male sexual dysfunction. Scand
J Urol Nephrol 1997;31:271-274.
Lee YH, Lee WC, Chen MT, Huang JK,
Chung C, Chang LS: Acupuncture in the
treat­ment of renal colic. J Urol 1992;147:
16-19.
Philipp T, Shah PRS, Worth PHL: Acupunc-
ture in the treatment of bladder instability.
Br J Urol 1988;61:490-497.
Zhiyuan Q: Clinical observation of 54 cases
of male infertility treated by acupuncture
and moxibustion. J Chin Med 1997;52:
12-13.
Xinhun H: Acupuncture plus medication
for male idiopathic oligospermatic sterility.
Shanghai J Acupunct Moxib 1998;2:35-37.
Wu J: 100 cases of impotence treated by
acupuncture and moxibustion. J Trad Cin
Med 1989;9:184-185.
Curr Urol 2007;1:39-41
17 Ahn SY, Saam-Ohang: Acupuncture treat-
ment methods of impotence in male sex
clinic. J Orient Med 1991;1:200-202.
18 Engelhardt PF, Daha LK, Zils T, König K,
Pflüger H: Acupuncture in the treatment
of psychogenic erectile dysfunction: first
results of a prospective randomized plcebo-
controlled study. Int J Impo Res 2003;15:
343-346.
19 Rosen RC, Riley A, Wagner G, Osterloh IH,
Kirkpatrick J, Mishra A: The International
Index of Erectile Function (IIEF): a multi-
dimensional scale for assessment of erectile
dysfunction. Urology 1997;49: 822-830.
20 Kubiena G, Meng A, Petricek E, Petricek U:
Handbuch der Akupunktur. Der Chinesische
und der moderne Weg.Wien, Orac Verlag,
1991.
21 Li Z, Ye C: Treatment impotence with tra-
ditional Chinese medicine coordinated by
acupuncture and moxibustion. J Trad Chin
Med 1988;8:121-122.
22 Heine H: Periphere Schmerzverarbeitungan
Gelenken durch Akupunktur-Bedeutung des
Parasympathikus. Deutsch. Zschr. Akup.
2004;47:15-23.
23 Heine H: Die bedeutung der grundregula-
tion für neuraltherapie, akupunktur und
Homöopathie. Erfahrungsheilkunde 2005;
54:170-175.
41