Erectile dysfunction

The 2018 guideline of the American Urological Association (AUA) defines erectile dysfunction as the consistent or recurrent inability to attain or keep an erection sufficient for sexual satisfaction. Trials divide it into psychogenic erectile dysfunction, where no physical cause is found, and organic erectile dysfunction, which has a physical cause such as diabetes or a stroke. Most measure it with the IIEF-5, the five-question International Index of Erectile Function, on which a higher score means better erections. The acupuncture trials compare needling with sham acupuncture, a control procedure built to resemble it; with PDE5 inhibitors such as sildenafil and tadalafil, the tablets guidelines use first; with herbal medicine; or add acupuncture to one of these.

No Cochrane review

Cochrane has published no review of acupuncture for erectile dysfunction. Its reviews of the condition cover drugs, devices and supplements, among them a 2025 review of low-intensity shockwave therapy and a 2021 review of ginseng. The most recent review limited to acupuncture is the 2026 meta-analysis by Yan and colleagues at Guizhou University of Traditional Chinese Medicine, published in the International Society for Sexual Medicine's journal Sexual Medicine Reviews.

Systematic reviews

Yan and colleagues searched eight Chinese and English databases and pooled 21 randomised trials. In their abstract, acupuncture raised IIEF-5 scores by about 3 points and erection hardness scores by 0.75, and more men were rated as responding. They found no difference in adverse events, rated the certainty of the evidence from very low to moderate, and wrote that the weak evidence precludes definitive conclusions. The abstract does not separate sham, drug and add-on comparisons, and AcuiQ could not open the full text to check them. Three of its authors also wrote the 2024 trial against sildenafil described below.

A 2026 network meta-analysis by He and colleagues at Sichuan Provincial People's Hospital compared five treatments without drugs, acupuncture-based therapies among them, in randomised trials. Its abstract reports the largest IIEF-5 gain over sham for electrical stimulation combined with exercise, and says the other treatments ranked lower without giving a figure for acupuncture.

The 2019 review by Lai and colleagues at Beijing University of Chinese Medicine, published in the World Journal of Men's Health, is the most recent with full text open to read. Fourteen of its 22 trials enrolled men with psychogenic erectile dysfunction, and two had type 2 diabetes. Only two trials used a sham control, and they disagreed: electroacupuncture showed no difference from sham needling at non-acupuncture points in a 1997 trial by Aydin and colleagues, while manual acupuncture was better than needling at headache points in the Engelhardt trial; the review rated both comparisons very low certainty. Acupuncture added to tadalafil gave higher IIEF-5 scores than tadalafil alone in two trials, at low certainty, and acupuncture added to herbal medicine did better than the herbs alone in seven. Safety was poorly reported: two trials recorded flushing, dizziness, a stuck needle and itching. The authors concluded that low-quality evidence suggests a benefit of acupuncture as an add-on treatment, mainly in psychogenic erectile dysfunction. The points the trials used most were CV04 (Guanyuan), SP06 (Sanyinjiao), BL23 (Shenshu) and ST36 (Zusanli), followed by GV04 (Mingmen), LV03 (Taichong), KD03 (Taixi) and BL32 (Ciliao); the review writes them CV4, SP6, BL23, ST36, DU4, LR3, KI3 and BL32.

Earlier reviews found less. The 2016 review by Cui and colleagues at Guang'anmen Hospital in Beijing found the same two sham-controlled trials and a Chinese trial in which acupuncture added to psychological therapy did better than psychological therapy alone. It did not pool the sham trials, because their shams differed, and concluded the evidence that acupuncture alone improves erectile dysfunction was insufficient. The 2009 review by Lee, Shin and Ernst in BJU International searched 15 databases and reached the same conclusion, naming small samples and poor reporting. A 2021 review by Abdi and colleagues covered sexual dysfunction in women and men together and found high-quality evidence lacking.

Trials

In the 2003 trial by Engelhardt and colleagues at Lainz Hospital in Vienna, 22 men with psychogenic erectile dysfunction were randomised to points chosen for erectile dysfunction or to points chosen for headache, and men who did not respond to the headache points crossed over. A satisfactory response came in 68% of the treatment group and 9% of the control group. The authors called it a pilot study. According to the Cui review, the treatment points included CV04 (Guanyuan), CV06 (Qihai), KD06 (Zhaohai), SP06 (Sanyinjiao) and BL23 (Shenshu). An earlier 1999 pilot study by Kho and colleagues in Nijmegen gave electroacupuncture to 16 men without a control group, found no change in stress or sex hormones, and reported better erections in 15%; the authors drew no definite conclusion.

The 2023 trial by Wang and colleagues at Xiyuan Hospital in Beijing randomised 66 men with psychogenic erectile dysfunction to 18 sessions of acupuncture over six weeks or to sham needling at sites off the meridians and away from acupuncture points. IIEF-5 and hardness scores improved in both groups and more with acupuncture, as did anxiety and depression scores; there were no serious adverse events. Asked at the end which treatment they had received, the two groups answered alike. The points were GV20 (Baihui), PC06 (Neiguan), CV04 (Guanyuan), CV03 (Zhongji), KD12 (Dahe), KD03 (Taixi) and LV03 (Taichong). The trial ran at one centre and followed men for four weeks after treatment.

Two Chinese trials, both published in Chinese with English abstracts, tested other comparisons. The 2024 trial by Zhu and colleagues randomised 64 men to acupuncture every other day for 30 days or to 50 mg of sildenafil before sex. IIEF-5 scores rose in both groups and the response rate did not differ, and two weeks after treatment ended the acupuncture group scored higher. A 2023 trial by Lai and colleagues in Fujian randomised 58 men with erectile dysfunction after a stroke, all receiving routine care that included rehabilitation and ordinary acupuncture, to electroacupuncture at the eight Baliao points over the sacrum, which include BL32, or to shallow needling with electrical current 20 mm to the side. IIEF-5 scores and pelvic floor muscle contraction improved more with the Baliao points.

What guidelines say

The European Association of Urology's Sexual and Reproductive Health guideline, in its 2026 edition, a limited update of 2025 whose new literature search covered other sections, does not mention acupuncture. It strongly recommends lifestyle changes and PDE5 inhibitors as first-line treatment, and weakly recommends L-arginine or ginseng for men with mild erectile dysfunction who refuse drugs.

The AUA guideline, which the AUA's site carries as the 2018 version, also does not mention acupuncture. Of the newer non-drug treatments it covers, it calls low-intensity shockwave therapy and stem cell injections investigational and platelet-rich plasma experimental.

The 2025 recommendations of the Fifth International Consultation on Sexual Medicine on medical management name PDE5 inhibitors as first-line treatment for most men in their abstract; AcuiQ could not open the full text to check what they say about acupuncture. A 2026 comparison of eleven erectile dysfunction guidelines by Gillman and Chung found them agreed on first-line drug treatment and does not mention acupuncture. Clinical guidelines compares how guideline bodies treat acupuncture across conditions.

What the reviews could not settle

In the reviews AcuiQ could read in full, the comparison with sham rests on two small trials from 1997 and 2003 in men without a physical cause, which disagreed; the Wang trial added 66 such men in 2023. The one trial with an off-point control in organic erectile dysfunction, after stroke, gave both groups routine care as well. Whether results differ between psychogenic and organic erectile dysfunction is untested: Lai and colleagues found most trials enrolled psychogenic cases and four did not say which kind. Against a PDE5 inhibitor, the Zhu trial ran for 30 days with two weeks of follow-up, and Lai and colleagues rated trials against drugs at high risk of bias because a needle and a tablet cannot be blinded. The shams differed, from headache points to needling beside the points, and Sham acupuncture sets out what each kind of control does and does not rule out. Cui and Lai both found safety too poorly reported to judge. The difficulty is not specific to acupuncture: a 2026 umbrella review by Ma and colleagues rated 13 of 23 meta-analyses of erectile dysfunction treatments critically low quality. Erectile dysfunction also appears in trials for other conditions, as in Chronic prostatitis and chronic pelvic pain syndrome, and Premature ejaculation reports a related evidence base.

AcuiQ's erectile dysfunction page lists the protocols individual studies prescribed, each with its citation.