{"paper_id":"38376aea-c2b7-47d2-9569-66238446ec0e","body_text":"Schwerpunkt.......\nNora Giese1,2,M i k eA r m o u r1,3,4\n1NICMHealthResearchInstitute,WesternSydneyUniversity,Westmead,Australia\n2PraxisfürChinesischeMedizin,Bonn,Germany\n3TranslationalHealthResearchInstitute(THRI),WesternSydneyUniversity,Penrith,Australia\n4MedicalResearchInstituteofNewZealand(MRINZ),Wellington,NewZealand\nDoes anyone care about sex?\nClinicalguidanceonacupuncturefordyspareuniainendometriosis\nEndometriosis is characterized by the\npresence of endometrium-like tissue\noutside the uterus [1] and affects around\n10–15% of women of reproductive age\nand those assigned female at birth [2].\nThe most common symptoms include\na variety of pelvic pain symptoms such\nas painful periods (dysmenorrhea), pain\nin the pelvis (non-cyclical pelvic pain),\npain with urination (dysuria) or bowel\nmotions (dyschezia), and painful sex or\ndyspareunia [3].\n» Endometriosis\nnegatively impacts all\naspects of sexual function\nThe risk of developing dyspareunia is\nninefold greater in people with en-\ndometriosis compared to the general\nfemale population [4], and almost 70%\nof women with endometriosis report\npainful sex, with one third reporting\nthey have pain every time they have sex.\nIt is not surprising then that over 80% of\nwomen with dyspareunia report either\navoiding or interrupting sexual inter-\ncourse [3]. People with deep infiltrating\nendometriosis are especially affected,\nmainly due to the infiltration of the car-\ndinal and uterosacral ligaments—known\nfor their considerable nerve fiber con-\ntent, which can cause pain during sexual\nintercourse if tense—the Douglas cavity,\nthe anterior rectalwall, and the posterior\nvaginal fornix [4].\nDtschZAkupunkt2025·68(4):215–218\nhttps://doi.org/10.1007/s42212-025-00765-2\nAccepted:31July2025\nPublishedonline:3September2025\n©TheAuthor(s)2025\nThe impairment of sexual function in\npeople with endometriosis, however, is\nnot limited to dyspareunia. The sexual\nresponse cycle can be negatively affected\nby psychological factors such as anxiety\nand fear of pain, which are determined\nby persistent experiences of painful sex-\nualintercoursethatresultindisordersre-\nlated to desire, lubrication, arousal, and\norgasm [4]. Women with endometrio-\nsis-related chronic pelvic pain reported\na significantly reduced ability to experi-\nence an orgasm during intercourse [5].\nPeople with rectovaginal endometriosis\nhaveathreefold greaterriskofbeingsex-\nually unsatisfied or experiencing little or\nno sexual pleasure, resulting in fear be-\nfore or during sexual intercourse, avoid-\nance of sexual activities [6], and feel-\nings of guilt toward the partner [4]. Al-\nthough the impact of endometriosis ex-\ntends far beyond pain, the current liter-\nature mainly focuses on dyspareunia re-\ngarding the sexual well-being of people\nwith endometriosis.\nTreatment options\nClinical guidelines recommend pharma-\ncologicaltreatments(combinedoralcon-\ntraceptives and progestogens) or surgery\nto reduce pain symptoms and improve\nsexual function [4, 7]. However, satisfac-\ntion rates with hormonal treatment are\nlow due to significant side effects [8, 9].\nLaparoscopic excision has also shown\nbenefits in improving sexual function\nand reducing discomfort during sexual\nintercourse after 4–12 months, as well as\nafter 5 years; however, over one third of\nwomen will require repeated surgery [4].\nGiven the significant burden caused\nby endometriosis, effective and accept-\nable treatment options that are in line\nwith patients’ needs are urgently re-\nquired. The number one priority for\npeople with endometriosis is an effec-\ntive treatment [ 10], and accordingly,\nthey seek help beyond the recommen-\ndations of clinical guidelines. A cross-\nsectional survey (n=1575) found 82.8%\nof people with endometriosis and their\nfamily members wanted more research\ninto treatment options; over half of these\npeople (43.6%) noted an interest in com-\nplementary and alternative medicine\n(CAM) treatments [ 11]. The World\nHealth Organization (WHO) reported\nthat acupuncture is the most widely\nused traditional and complementary\nmedicine worldwide [12]. A retrospec-\ntive evaluation, undertaken by Schwartz\net al.in Switzerland using medicalcharts\nand a questionnaire (n=574), found that\n62.5% of women with endometriosis\nsought CAM support, with one quarter\nchoosing acupuncture/traditional Chi-\nnese medicine (TCM; [13]).\nAcupuncture for dyspareunia\nAcupuncture has shown promising re-\ns u l t si nr e l i e v i n gt h ep a i ns y m p t o m so f\nendometriosis and has been suggested\nfor people with endometriosis who do\nnotexperiencereliefwith usualcare[ 14].\nHowever, data on acupuncture for dys-\npareunia are limited.\nA Brazilian randomized controlled\ntrial (RCT) reported a 65% decrease in\nsexual pain using a 0–10-point visual\nanalogue scale after five acupuncture\ntreatments compared to a 13% reduc-\ntion after five sessions of simulated\nacupuncture ( n=42, mean difference\n[MD] –2.88, [–3.83, –1.93],p<0.00001),\nwhich was also found at the 2-month\nfollow-up ( n=42, MD –3.86, [–4.77,\n–2.95], p<0.00001; [ 15]). This study\nwas included in a systematic review\nand meta-analysis that also reported\non a Chinese RCT that found a posi-\ntive effect of acupuncture compared to\ndanazol; however, the difference was not\n4·2025 DeutscheZeitschriftfürAkupunktur 215\n\nSchwerpunkt..........\nAbstract · Zusammenfassung\nN. Giese · M. Armour\nDoesanyonecareaboutsex?Clinicalguidanceonacupuncturefordyspareuniainendometriosis\nAbstract\nEndometriosisaffectsvariousphysiologicalandpsychologicalaspectsof\nsexuallife.Aroundtwothirdsofpatientswithendometriosisexperience\npainduringsexualintercourse(dyspareunia),especiallythosewithdeep\ninfiltratingendometriosis. Therepeatedexperienceofpaincanresultin\nsexualavoidance,reducedpleasure,anddistressinthepartnership.\nNot all of these patients can be treated satisfactorily with the\nrecommended therapies(hormones orsurgery). Asanalternativeor\ncomplementarytreatment,acupunc turehasbeensuggested.Although\nthestudiesonacupunctureforendometriosis-relatedpainsymptoms\narepromising,thespecificquestionofhowtotreatdyspareuniahasso\nfarreceivedlittleattentioninresearchandintheliterature.\nBasedonthecurrentstateofresearch, this articlesummarizes the\ndetailsofacupuncturetreatmentfor dyspareunia.This includesthe\nselectionofsuitableacupuncturepoints(localanddistantpoints),the\nmostimportanttreatmentstrategies(invigoratingQiandBloodinthe\nlowerabdomen,tonifyingSpleenandStomach,resolving Dampness,\ncalmingShen), andotheracupuncturetreatmentspecificssuchas\nfrequencyandduration.\nTheaimistoprovidetherapistswithconcreteguidanceforindividuali-\nzedtreatmentinclinicalpracticeandtoraiseawarenessofthisoften-\noverlookedsymptom.\nKeywords\nPain·Sexualintercourse·Alternativemedicine ·TraditionalChinese\nmedicine·Complementarytherapy\nInteressiertsichirgendjemandfürSex?Anleitun gzurAkupunkturbehandlu ngvonDyspareuniebei\nEndometriose\nZusammenfassung\nEndometriose beeinträchtigt verschiedene physiologische und\npsychologischeAspektedes Sexuallebens. Etwazwei Drittel der\nEndometriosepatientinnen erlebenSchmerzen beimGeschlechtsver-\nkehr(Dyspareunie), insbesondere diejenigen mittief infiltrierender\nEndometriose. Die wiederholte Schmerzerfahrung kannzusexueller\nVermeidung, reduziertem Lustempfindenundpartnerschaftlicher\nBelastungführen.MitdenempfohlenenTherapien(HormoneoderOpe-\nration)könnennichtalleEndometriosepatientinnenzufriedenstellend\nbehandeltwerden; alternativoderergänzend wurde dieBehandlung\nmitAkupunkturvorgeschlagen.ObwohldieStudienlagezuAkupunktur\nbeiendometriosebedingten Schmerzsymptomenvielversprechend ist,\nfindetdie spezifischeFragenachderBehandlungvonDyspareunie\nbislangwenigBeachtunginForschungundFachliteratur.AufGrundlage\nder aktuellenForschungslagefasst dieser Artikel die Details der\nAkupunkturbehandlungbeiDyspareuniezusammen.Dazugehörendie\nAuswahlgeeigneter Akupunkturpunkte(Lokal-undFernpunkte),die\nwichtigstenTherapiestrategien(QiundBlutimUnterbauchbewegen,\nMilzundMagenstärken,Feuchtigkeittransformieren undausleiten,\nShenberuhigen)sowieweitereBehandlungsdetailswieHäufigkeitund\nDauerderBehandlung.Zielistes,Therapeut:innenkonkreteImpulse\nfürdie individualisierte Behandlunginder Praxiszugeben unddas\nBewusstseinfürdieseoftüberseheneSymptomatikzuschärfen.\nSchlüsselwörter\nSchmerzen ·Geschlechtsverkehr ·AlternativeMedizin ·Traditionelle\nchinesischeMedizin·Komplementärtherapie\nstatistically significant (n=26, risk ratio\n1.07, [0.57, 2.00],p=0.84).\n» Research suggests that\nacupuncture can improve\ndyspareunia\nAn Italian pilot study without a control\ngroup reportedthat 19 of 34 women with\ndeep infiltrating endometriosis experi-\nenced dyspareunia. Sexual pain scores\nwere reported to decrease from a mean\nintensity of 5.74 before treatment to 3.89\non a 0–10 numerical rating scale after\n15 acupuncture treatments (p<0.0001;\n[16]).\nAChineseRCTreportednochangein\ndyspareunia after acupuncturecompared\nto superficial needling, but the baseline\npain scores were 0, which does not allow\nfor improvement.\nAcupuncture treatment details\nIn both studies with significant positive\nfindings, TCM-style manual acupunc-\nture was used with a fixed acupuncture\nprotocol. In both cases, a combination of\nlocal and distant points was used. While\nin both studies a treatment frequency of\nonce a week was chosen, the duration\ndiffered considerably from 5 weeks (five\ntreatment sessions in total) to 6 months\n(15 treatment sessions in total). Both\npublications did not report on any other\ncomponent of treatment (\nTable 1).\nDiscussion\nFindings suggest that acupuncture can\nimprove pain during sexual intercourse\nin people with endometriosis. Even\na small number of five treatments may\nbe enough to cause significant changes.\nThe main treatment strategy was to in-\nvigorate Qi and Blood especially in the\nlower abdomen in order to alleviate\npain (LIV-3, SP-6, SP-10, Ren-3, BL-17,\nGB-29, L.I.-4, SP-8, Ren-6, ST-29, BL-\n32, Zigong, LIV-8, KID-10). Additional\nstrategies were to tonify Spleen and\nStomach (SP-6, ST-36, Ren-6), resolve\ndampness (SP-6, Ren-3, SP-9, KID-10),\nand calm the Shen (P-6; [17]).\nHowever, the total number of studies\ninvestigating the effect of acupuncture\non dyspareunia was small with limited\nsample sizes. Additionally, the persis-\ntence of an effect has only been evalu-\nated in one study after 2 months, and\ntherefore prolonged effect sizes remain\nunclear. Furthermore, these acupunc-\nture treatment details may not reflect the\nidealtreatmentfordyspareunia,sincethe\nacupuncture protocols were not specif-\nically designed to treat dyspareunia in\nendometriosis, but to treat the breadth\nof pain symptoms in endometriosis.\n216 DeutscheZeitschriftfürAkupunktur 4·2025\n\nSchwerpunkt.......\nTable 1 Acupuncturetreatmentdetailsusedforpaininendometriosisincludingdyspareunia\nAcupuncture detail As used in research\nAcupunctureratio-\nnale\nTCM-styleacupuncture\nFixed protocols\nDetailsofneedling 19a–20b needleinsertionsperindividualpersession\nAcupuncturepointsincludedinbothprotocols\nLIV-3,SP-6,SP-10,Ren-3\nIncludedinoneprotocol\nBL-17,GB-29,ST-36,LIV-8,SP-9,KID-10 a\nL.I.-4,SP-8,P-6,Ren-6,ST-29,BL-32,Zigong(M-CA-18) b\nNeedleinsertionbilaterally a,b\nDepthofinsertion:0.5-2cun b\nDeQiobtained b,nofurtherstimulation b\n20á–30bminneedleretentiontime\nUsingdisposablesterilestainless-steelneedles a,b\nTreatmentregimen 5b–15a treatments\nWeeklya/weeklyfor12weeks,thenthreemonthlysessions b\n5weeksa/6monthsintotal b\nTCM traditional Chinese medicine\na[15]\nb[16]\nThe main treatment strategy to move\nQiandBloodaligns with major textbook\nrecommendations for endometriosis-\nrelated pain [18, 19]. However, strate-\ngies to treat the base root as well, such\nas strengthening the Kidneys and ad-\ndressing either heat or cold, which is\nsuggested to be vital by expert consen-\nsus if present [20], are omitted in both\nprotocols. Furthermore, standardized\nacupuncture protocols were used, which\nhave been criticized for lacking ecolog-\nical validity [21], and treatment effects\nmay be underestimated [22].\n» The main treatment\nstrategy is to invigorate\nQi and Blood in the pelvic\narea\nBoth addressing the root cause and indi-\nvidualizing the treatment are especially\nimportant in this context, since the im-\npact of endometriosis on sexual func-\ntion is not limited to pain but includes\narange of further physiological functions\n(desire/arousal, orgasm, satisfaction) and\npsychological components (anxiety, fear\nof pain, feelings of guilt toward the part-\nner). Given that acupuncture is claimed\nto be a holistic modality providing both\nphysical and psychological treatment as-\npects [23], it is likely that acupuncture\nhas the potential to treat the complexity\nof sexual dysfunction rather than pain\nalone.\nInterestingly, a cross-sectional survey\nin Australia and New Zealand including\n111 TCM practitioners showed that dys-\npareunia was an uncommon presenting\nsymptom (n=15, 13.5%), despite affect-\ning almost three quarters of women with\nchronicpelvicpain[ 24].Theauthors dis-\ncussed whether this may reflect the nor-\nmalization of pelvic pain associated with\nthe menstrual cycle and/or TCM practi-\ntioners overlooking signs and symptoms.\nThe neglect of dyspareunia and sexual\nfunction in people with endometriosis\nin research is even more pronounced in\ntextbooks on endometriosis, where dys-\npareunia is rarely mentioned, with only\none case of a woman with dyspareunia\nbeing reported. Her TCM diagnosis was\nQi stagnation and blood stasis, and the\ntherapeutic strategy accordingly was to\nregulate Qi to invigorate blood circula-\ntion and to resolve stasis to stop pain.\nHowever, no acupuncture details were\ngiven for this case.\nBased on the current literature, it\nremains unclear why the treatment of\ndyspareunia is omitted in almost all\ntextbooks and most clinical research on\nacupuncture for endometriosis. While\nt h e r ea r em a n yp o s s i b l ee x p l a n a t i o n sa t\ndifferent levels, we must critically ask\nourselves whether we—TCM practition-\ners, authors, and researchers—consider\nsexual well-being in people with en-\ndometriosis to be a negligible luxury.\nConclusion\nA range of acupuncture details for dys-\npareunia have been presented. However,\nstudies including dyspareunia are very\nlimited and have not specifically focused\non the treatment of dyspareunia or sex-\nual function but on pelvic pain symp-\ntoms in general.\nReferences\n1. 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EvansSetal(2022)Treatmentuseandsatisfaction\ninaustralianwomenwithendometriosis:amixed-\nmethodsstudy.InternMedJ52(12):2096–2106\n9. BurlaLetal(2021)Popularityofendocrine\nendometriosisdrugsandlimitedalternativesinthe\npresentandforeseeablefuture:asurveyamong\n1420affectedwomen.EurJObstetGynecolReprod\nBiol262:232–238\n10. GieseNetal(2023)Unmetneedsofaustraliansin\nendometriosisresearch:aqualitativestudyof\nresearchpriorities,drivers,andbarriersto\nparticipationinpeoplewithendometriosis.\nMedicina59(9):1655\n11. BradyPCetal(2020)Researchprioritiesfor\nendometriosisdifferamongpatients,clinicians,and\nresearchers.AmJObstetGynecol222(6):630–632\n12. -(2019)WHOglobalreportontraditionaland\ncomplementarymedicine2019.WorldHealth\nOrganization,Geneva,p226\n13. SchwartzASKetal(2019)Theuseofhomeremedies\nandcomplementaryhealthapproachesin\nendometriosis.ReprodBiomedOnline\n38(2):260–271\n14. GieseN,KwonKK,ArmourM(2023)Acupuncturefor\nendometriosis:asystematicreviewandmeta-\nanalysis.IntegrMedRes12(4):101003\n15. deSousaTRetal(2016)Theeffectofacupuncture\nonpain,dyspareunia,andqualityoflifeinBrazilian\nwomenwithendometriosis:arandomizedclinical\ntrial.ComplementTherClinPract25:114–121\n16. ChiarleGetal(2024)Acupunctureforpainand\npain-relateddisabilityindeepinfiltrating\nendometriosis.FrontPainRes5:1279312\n17. DeadmanP,Al-KhafajiM,BakerK(2007)Amanual\nofacupuncture,2ndedn.vol675.England:Journal\nofChineseMedicinePublications,Hove,EastSussex\n18. MaciociaG(2011)Obstetricsandgynecologyin\nchinesemedicine,2ndedn.GB:ChurchillLivingstone\n19. LyttletonJ(2013)Treatmentofinfertilitywith\nchinesemedicine,2ndedn.GB:ChurchillLivingstone\n20. GieseN,HeirsMK(2023)Developmentofprovisional\nacupunctureguidelinesforpelvicpainin\nendometriosisusingane-Delphiconsensusprocess.\nJIntegrComplementMed29(3):169–180\n21. SchnyerRNetal(2006)Standardizationof\nindividualizedtreatmentsinarandomized\ncontrolledtrialofacupunctureforstroke\nrehabilitation.JAlternComplementMed\n12(2):106–109\n22. SchnyerRNetal(2008)Developmentofprotocolsfor\nrandomizedsham-controlledtrialsofcomplex\ntreatmentinterventions:Japaneseacupuncturefor\nendometriosis-relatedpelvicpain.JAltern\nComplementMed14(5):515–522\n23. LiuWetal(2022)Researchmethodologyin\nacupunctureandmoxibustionformanaging\nprimarydysmenorrhea:ascopingreview.\nComplementTherMed71:102874\n24. ArentzSetal(2021)Across-sectionalstudyof\ntraditionalchinesemedicinepractitioner’s\nknowledge,treatmentstrategiesandintegrationof\npracticeofchronicpelvicpaininwomen.Bmc\nComplementMedTher21(1):174\nCorrespondingaddress\nNora Giese\nNICMHealthResearch\nInstitute\nWesternSydneyUniversity\n158HawkesburyRd,\n2145Westmead,Australia\nN.Giese@westernsydney.edu.au\nFunding. OpenAccessfundingenabledandorga-\nnizedbyCAULanditsMemberInstitutions\nPublisher’s Note. SpringerNatureremainsneutral\nwithregardtojurisdictionalclaimsinpublishedmaps\nandinstitutionalaffiliations.\nDeclarations\nConflict of interest. N.GieseandM.Armour\ndeclarethattheyhavenocompetinginterests.\nForthisarticlenostudieswithhumanpartici-\npantsoranimalswereperformedbyanyofthe\nauthors.Allstudiesmentionedwereinaccor-\ndancewiththeethicalstandardsindicatedin\neachcase.\nOpen Access.DieserArtikelwirdunterderCre-\nativeCommonsNamensnennung4.0Interna-\ntionalLizenzveröffentlicht,welchedieNutzung,\nVervielfältigung,Bearbeitung,Verbreitungund\nWiedergabeinjeglichemMediumundFormat\nerlaubt,sofernSieden/dieursprünglichenAu-\ntor(en)unddieQuelleordnungsgemäßnennen,\neinenLinkzurCreativeCommonsLizenzbeifügen\nundangeben,obÄnderungenvorgenommen\nwurden.DieindiesemArtikelenthaltenenBilder\nundsonstigesDrittmaterialunterliegeneben-\nfallsdergenanntenCreativeCommonsLizenz,\nsofernsichausderAbbildungslegendenichts\nanderesergibt.SoferndasbetreffendeMaterial\nnichtunterdergenanntenCreativeCommons\nLizenzstehtunddiebetreffendeHandlungnicht\nnachgesetzlichenVorschriftenerlaubtist,istfür\ndieobenaufgeführtenWeiterverwendungen\ndesMaterialsdieEinwilligungdesjeweiligen\nRechteinhaberseinzuholen.WeitereDetailszur\nLizenzentnehmenSiebittederLizenzinforma-\ntionauf http://creativecommons.org/licenses/\nby/4.0/deed.de.\nIneigenerSache\nSchwerpunktübersicht\nDeutsche Zeitschrift für\nAkupunktur\nDieDeutscheZeitschriftfürAkupunktur bie-\ntetIhnenumfassendeundaktuelleBeiträge\nzu interessantenThemenschwerpunkten\naus allenBereichender Akupunkturund\nverwandterVerfahrenimSinneeinerinte-\ngrativenMedizin.\nÜberblick 2023\n4 1/23NachhaltigkeitinderChinesischen\nMedizin\n4 2/23JochenGleditsch:Forschergeist,\nFördererundWegbereiter\n4 3/23Hüfte\n4 4/23AusleitendeVerfahren\nÜberblick 2024\n4 1/24TCMimKindes-undJugendalter\n4 2/24StrategiengegenAllergien\n4 3/24DieBehandlungdesFußes\n4 4/24Reproduktionsmedizin\nAlleInhaltederZeitschriftfindenSieunter\nwww.springermedizin.de/dza.\nSpringerMedizin.debietetIhnenZugangzu\nallenelektronischverfügbarenAusgaben\nIhrer Zeitschrift–unabhängigdavon, seit\nwannSiedieZeitschriftabonnierthaben.\nMöchtenSieeinbereitserschienenesHeft\nnachbestellen?EinzelneAusgabenkönnen\nSiedirektbeiunseremKundenservicezum\nPreisvon jeEUR 46,– zzgl. 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