Does anyone care about sex?

· Zusammenfassung N. Giese · M. Armour Doesanyonecareaboutsex?Clinicalguidanceonacupuncturefordyspareuniainendometriosis

Endometriosisaffectsvariousphysiologicalandpsychologicalaspectsof sexuallife.Aroundtwothirdsofpatientswithendometriosisexperience painduringsexualintercourse(dyspareunia),especiallythosewithdeep infiltratingendometriosis. Therepeatedexperienceofpaincanresultin sexualavoidance,reducedpleasure,anddistressinthepartnership. Not all of these patients can be treated satisfactorily with the recommended therapies(hormones orsurgery). Asanalternativeor complementarytreatment,acupunc turehasbeensuggested.Although thestudiesonacupunctureforendometriosis-relatedpainsymptoms arepromising,thespecificquestionofhowtotreatdyspareuniahasso farreceivedlittleattentioninresearchandintheliterature. Basedonthecurrentstateofresearch, this articlesummarizes the detailsofacupuncturetreatmentfor dyspareunia.This includesthe selectionofsuitableacupuncturepoints(localanddistantpoints),the mostimportanttreatmentstrategies(invigoratingQiandBloodinthe lowerabdomen,tonifyingSpleenandStomach,resolving Dampness, calmingShen), andotheracupuncturetreatmentspecificssuchas frequencyandduration. Theaimistoprovidetherapistswithconcreteguidanceforindividuali- zedtreatmentinclinicalpracticeandtoraiseawarenessofthisoften- overlookedsymptom.

Pain·Sexualintercourse·Alternativemedicine ·TraditionalChinese medicine·Complementarytherapy InteressiertsichirgendjemandfürSex?Anleitun gzurAkupunkturbehandlu ngvonDyspareuniebei Endometriose Zusammenfassung Endometriose beeinträchtigt verschiedene physiologische und psychologischeAspektedes Sexuallebens. Etwazwei Drittel der Endometriosepatientinnen erlebenSchmerzen beimGeschlechtsver- kehr(Dyspareunie), insbesondere diejenigen mittief infiltrierender Endometriose. Die wiederholte Schmerzerfahrung kannzusexueller Vermeidung, reduziertem Lustempfindenundpartnerschaftlicher Belastungführen.MitdenempfohlenenTherapien(HormoneoderOpe- ration)könnennichtalleEndometriosepatientinnenzufriedenstellend behandeltwerden; alternativoderergänzend wurde dieBehandlung mitAkupunkturvorgeschlagen.ObwohldieStudienlagezuAkupunktur beiendometriosebedingten Schmerzsymptomenvielversprechend ist, findetdie spezifischeFragenachderBehandlungvonDyspareunie bislangwenigBeachtunginForschungundFachliteratur.AufGrundlage der aktuellenForschungslagefasst dieser Artikel die Details der AkupunkturbehandlungbeiDyspareuniezusammen.Dazugehörendie Auswahlgeeigneter Akupunkturpunkte(Lokal-undFernpunkte),die wichtigstenTherapiestrategien(QiundBlutimUnterbauchbewegen, MilzundMagenstärken,Feuchtigkeittransformieren undausleiten, Shenberuhigen)sowieweitereBehandlungsdetailswieHäufigkeitund DauerderBehandlung.Zielistes,Therapeut:innenkonkreteImpulse fürdie individualisierte Behandlunginder Praxiszugeben unddas BewusstseinfürdieseoftüberseheneSymptomatikzuschärfen. Schlüsselwörter Schmerzen ·Geschlechtsverkehr ·AlternativeMedizin ·Traditionelle chinesischeMedizin·Komplementärtherapie statistically significant (n=26, risk ratio 1.07, [0.57, 2.00],p=0.84). » Research suggests that acupuncture can improve dyspareunia An Italian pilot study without a control group reportedthat 19 of 34 women with deep infiltrating endometriosis experi- enced dyspareunia. Sexual pain scores were reported to decrease from a mean intensity of 5.74 before treatment to 3.89 on a 0–10 numerical rating scale after 15 acupuncture treatments (p<0.0001; [16]). AChineseRCTreportednochangein dyspareunia after acupuncturecompared to superficial needling, but the baseline pain scores were 0, which does not allow for improvement. Acupuncture treatment details In both studies with significant positive findings, TCM-style manual acupunc- ture was used with a fixed acupuncture protocol. In both cases, a combination of local and distant points was used. While in both studies a treatment frequency of once a week was chosen, the duration differed considerably from 5 weeks (five treatment sessions in total) to 6 months (15 treatment sessions in total). Both publications did not report on any other component of treatment ( Table 1).

Findings suggest that acupuncture can improve pain during sexual intercourse in people with endometriosis. Even a small number of five treatments may be enough to cause significant changes. The main treatment strategy was to in- vigorate Qi and Blood especially in the lower abdomen in order to alleviate pain (LIV-3, SP-6, SP-10, Ren-3, BL-17, GB-29, L.I.-4, SP-8, Ren-6, ST-29, BL- 32, Zigong, LIV-8, KID-10). Additional strategies were to tonify Spleen and Stomach (SP-6, ST-36, Ren-6), resolve dampness (SP-6, Ren-3, SP-9, KID-10), and calm the Shen (P-6; [17]). However, the total number of studies investigating the effect of acupuncture on dyspareunia was small with limited sample sizes. Additionally, the persis- tence of an effect has only been evalu- ated in one study after 2 months, and therefore prolonged effect sizes remain unclear. Furthermore, these acupunc- ture treatment details may not reflect the idealtreatmentfordyspareunia,sincethe acupuncture protocols were not specif- ically designed to treat dyspareunia in endometriosis, but to treat the breadth of pain symptoms in endometriosis. 216 DeutscheZeitschriftfürAkupunktur 4·2025 Schwerpunkt....... Table 1 Acupuncturetreatmentdetailsusedforpaininendometriosisincludingdyspareunia Acupuncture detail As used in research Acupunctureratio- nale TCM-styleacupuncture Fixed protocols Detailsofneedling 19a–20b needleinsertionsperindividualpersession Acupuncturepointsincludedinbothprotocols LIV-3,SP-6,SP-10,Ren-3 Includedinoneprotocol BL-17,GB-29,ST-36,LIV-8,SP-9,KID-10 a L.I.-4,SP-8,P-6,Ren-6,ST-29,BL-32,Zigong(M-CA-18) b Needleinsertionbilaterally a,b Depthofinsertion:0.5-2cun b DeQiobtained b,nofurtherstimulation b 20á–30bminneedleretentiontime Usingdisposablesterilestainless-steelneedles a,b Treatmentregimen 5b–15a treatments Weeklya/weeklyfor12weeks,thenthreemonthlysessions b 5weeksa/6monthsintotal b TCM traditional Chinese medicine a[15] b[16] The main treatment strategy to move QiandBloodaligns with major textbook recommendations for endometriosis- related pain [18, 19]. However, strate- gies to treat the base root as well, such as strengthening the Kidneys and ad- dressing either heat or cold, which is suggested to be vital by expert consen- sus if present [20], are omitted in both protocols. Furthermore, standardized acupuncture protocols were used, which have been criticized for lacking ecolog- ical validity [21], and treatment effects may be underestimated [22]. » The main treatment strategy is to invigorate Qi and Blood in the pelvic area Both addressing the root cause and indi- vidualizing the treatment are especially important in this context, since the im- pact of endometriosis on sexual func- tion is not limited to pain but includes arange of further physiological functions (desire/arousal, orgasm, satisfaction) and psychological components (anxiety, fear of pain, feelings of guilt toward the part- ner). Given that acupuncture is claimed to be a holistic modality providing both physical and psychological treatment as- pects [23], it is likely that acupuncture has the potential to treat the complexity of sexual dysfunction rather than pain alone. Interestingly, a cross-sectional survey in Australia and New Zealand including 111 TCM practitioners showed that dys- pareunia was an uncommon presenting symptom (n=15, 13.5%), despite affect- ing almost three quarters of women with chronicpelvicpain[ 24].Theauthors dis- cussed whether this may reflect the nor- malization of pelvic pain associated with the menstrual cycle and/or TCM practi- tioners overlooking signs and symptoms. The neglect of dyspareunia and sexual function in people with endometriosis in research is even more pronounced in textbooks on endometriosis, where dys- pareunia is rarely mentioned, with only one case of a woman with dyspareunia being reported. Her TCM diagnosis was Qi stagnation and blood stasis, and the therapeutic strategy accordingly was to regulate Qi to invigorate blood circula- tion and to resolve stasis to stop pain. However, no acupuncture details were given for this case. Based on the current literature, it remains unclear why the treatment of dyspareunia is omitted in almost all textbooks and most clinical research on acupuncture for endometriosis. While t 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 different levels, we must critically ask ourselves whether we—TCM practition- ers, authors, and researchers—consider sexual well-being in people with en- dometriosis to be a negligible luxury.

A range of acupuncture details for dys- pareunia have been presented. However, studies including dyspareunia are very limited and have not specifically focused on the treatment of dyspareunia or sex- ual function but on pelvic pain symp- toms in general.

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SpringerNatureremainsneutral withregardtojurisdictionalclaimsinpublishedmaps andinstitutionalaffiliations. Declarations Conflict of interest. N.GieseandM.Armour declarethattheyhavenocompetinginterests. Forthisarticlenostudieswithhumanpartici- pantsoranimalswereperformedbyanyofthe authors.Allstudiesmentionedwereinaccor- dancewiththeethicalstandardsindicatedin eachcase. 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