Acupuncture modification treatment for female sexual dysfunction: A meta-analysis

This meta-analysis investigated the efficacy of acupuncture in treating female sexual dysfunction (FSD), a condition that significantly affects women's quality of life and their relationships. Female sexual dysfunction encompasses a range of problems such as decreased sexual desire, arousal difficulties, lubrication problems, difficulty reaching orgasm, and pain during sexual intercourse.

The researchers conducted a systematic search across five electronic databases (PubMed, Embase, Cochrane Library, CNKI, and CBM) through April 2023, looking for studies that investigated the use of acupuncture to treat FSD. To ensure quality and comparability of results, only studies that used the Female Sexual Function Index (FSFI) as the assessment instrument were included — a validated and widely used tool for measuring female sexual function.

After rigorous screening, 4 high-quality randomized controlled trials were included, involving a total of 178 participants. Three of the studies used traditional needle acupuncture, while one employed moxibustion. The most frequently used acupuncture points were Guan Yuan, Ren Yu, and San Yin Jiao, although there was some variation between studies.

Analysis of the results revealed important and nuanced findings. When compared with control groups, acupuncture treatment demonstrated statistically significant improvements in the total FSFI score (SMD=0.97, 95% CI: 0.27-1.68). This improvement was particularly evident in two specific domains: sexual desire and sexual arousal showed significant improvements with acupuncture treatment.

However, the results also showed important limitations. Acupuncture did not demonstrate significant efficacy in other aspects of female sexual function, including vaginal lubrication, ability to reach orgasm, overall sexual satisfaction, and reduction of pain during intercourse. These findings suggest that, while acupuncture may positively influence some aspects of the female sexual response, it may not fully address all components of sexual dysfunction.

The researchers proposed several explanations for these patterns of results. The improvement in sexual desire and arousal may be related to acupuncture's ability to activate neurons in the hypothalamus, a brain region crucial for hormonal and sexual regulation. This stimulation may function similarly to natural sexual stimulation, increasing the activity of excitatory neurons associated with sexual arousal.

On the other hand, the lack of improvement in vaginal lubrication may be related to the fact that acupuncture may actually reduce testosterone levels through the hypothalamic-pituitary-gonadal axis. Since testosterone is important for vaginal health and lubrication, this reduction could explain why acupuncture did not improve this specific aspect.

The absence of improvement in sexual satisfaction suggests that complex psychological factors — such as attitudes, beliefs, emotions, and stress — may not be adequately addressed by physical acupuncture treatment alone. This highlights the multidimensional nature of female sexuality, where physical and psychological components are intimately interconnected.

A significant limitation of the study was the high heterogeneity observed among the included studies (I²=86%), indicating considerable variation in results across different research projects. Subgroup analyses based on country, acupuncture modality, and treatment duration could not fully explain this heterogeneity, suggesting that other unmeasured factors — such as acupuncturist experience, specific application techniques, and individual patient characteristics — may influence outcomes.

This study contributes to the growing body of evidence on complementary therapies for female sexual health, offering a treatment option with few side effects and low cost. However, the results suggest that acupuncture may be more effective when used as part of an integrated therapeutic approach, combining physical and psychological interventions to address the multifactorial complexity of female sexual dysfunction.