Dry Needling for Erectile Dysfunction

The typical treatment for erectile dysfunction (ED) in mainstream medicine involves a life-long regimen of pills that temporarily relieve a symptom of the problem, but do nothing to resolve the problem itself. Tens of millions of American men are needlessly suffering from dysfunctional, deflated dingalings. This is not good. Viagra, Cialis, and other similar medications typically work on nitrous oxide pathways to increase concentrations in the blood and surrounding tissues. Increased nitrous oxide levels dilate vessels and elevate arterial blood perfusion to achieve the internal pressure necessary to passively close the venous valves allowing blood out of the penis. Once blood outflow is blocked and the penis is pressurized, erection is achieved and maintained. Hahaha… You just can’t not laugh after saying pressurized penis!

Counterintuitively, achieving an erection is predominantly a parasympathetic process. Muscles, both smooth and skeletal, need to relax enough to swell with sufficient blood. If the muscles are in a chronic state of sympathetic autonomic hyperactivity, the microvasculature supplying them with blood are not able to dilate enough to accommodate the necessary flow to fully close the veins.

If you read the medical research on erectile dysfunction, most of which is hot garbage, one may walk away assuming a few things: 1) There is no cure for erectile dysfunction. 2) The only muscles involved are the two closest muscles to the penis, the bulbospongiosus and the ischiocavernosus. 3) Prescription medication is the only solution in existence. None of this is true.

A minute percentage of men suffering from erectile dysfunction have some underlying structural pathology or genetic anomaly solely responsible for causing the problem. The overwhelming majority of erectile dysfunction cases are considered idiopathic, without a known cause, as are most chronic impairments affecting the US population. This is nonsense. The underlying cause is a sympathetic autonomic nervous system that is stuck in hyperactivity, inhibiting the parasympathetics from achieving harmonic balance with the sympathetics. As the sympathetic side of the autonomic nervous system increases output, parasympathetic output is concomitantly inhibited, leading to body wide muscular hypertonicity, hypoxia, and dysfunction. This is the primary underlying cause of erectile dysfunction for most men. This is awesome for all the affected guys out there, since addressing and reversing chronic sympathetic autonomic hyperactivity is actually quite simple.

The most negatively affected structures in the brain and body secondary to chronic sympathetic autonomic hyperactivity are the most parasympathetic-dominant structures. The most parasympathetic-dominant structure in the body is the vagus nerve, and the most parasympathetic-dominant group of muscles in the body are the 9 pelvic floor muscles. Therefore, the pelvic floor muscles are a group of muscles that suffer more from chronic sympathetic hyperactivity than others, leading to excessive rigidity and hypoxia. When one side of the autonomic nervous system goes up, the other goes down, impairing function of both.

Improved brain homeostasis is the underlying mechanism by which dry needling optimizes mental and physical health. Stressing tissues in our brain and body the right way, in the right amount, stimulates hormesis: positive cellular adaptation secondary to stress.

This is an awesome article reviewing a bunch of studies looking at the effect head and face needling has on cerebral blood flow, neuronal function, and patient outcomes.
Article: Jin G-Y, Jin LL, Jin BX, Zheng J, He BJ and Li S-J (2023) Neural control of cerebral blood flow: scientific basis of scalp acupuncture in treating brain diseases.

The results indicate the primary mechanism by which face and head needling work is through Brain alteration. Increased blood perfusion, decreased inflammation, and improved neuronal function were seen throughout numerous studies. Aside from needling research, which is typically considered weak secondary to lack of funding and resources, the rapid changes I see in my students and patients on a consistent basis, as far as I can figure, must be primarily occurring through dramatic alteration and improvement in brain health. A 0.2 mm, or so, needle does not cause all that much mechanical distortion to tissue. However, the small amount of distortion created through direct contact of muscular, tendinous, ligamentous, and periosteal tissue throughout the body stimulates immense amounts of homeostatic change in the brain.

The brain needs to be broken out of the protective mode it is stuck in. The brain and the body do not forget how to work. The problem is, something is disrupting communication between certain brain areas and other brain areas, and between certain brain areas and the body. Our systems become inhibited from using their full arsenal of healing superpowers. Direct contact of tissue is key, and is something only needling can accomplish. Without needles, aside from the skin, we are unable to directly contact anything. It is all indirect through the skin. The direct subcutaneous tissue distortion creates enough of an initial sympathetic stimulus to override the protective mechanism causing impairment, which then leads to parasympathetic-dominance compared to baseline. This is precisely what we need to happen to achieve homeostasis and resolve erectile dysfunction.

I always target the parasympathetic-dominant regions of the body with my first needles, then move on to treat whatever else. These regions include the sacral plexus, pelvic floor, upper cervical spine, auricular branch of the vagus nerve in the ear, Otic ganglion of the trigeminal nerve, and suture lines of the skull. This immediately pushes the autonomic nervous system in the direction we want it to go, in the parasympathetic direction, which is the overall result of needling in general. Targeting the parasympathetics first limits the amplitude and duration of the initial sympathetic spike elicited from being poked with sharp objects, which has been shown to last about 15 minutes on average in the studies looking into this. One of the reasons thoughtful needling is so powerful is it utilizes both sides of the autonomic nervous system. The initial sympathetic spike followed by parasympathetic dominance is apparently just what the brain needs to reestablish homeostasis.

The initial sympathetic spike is going to happen no matter what. It is the natural response to being poked with needles. The amplitude and duration of the initial sympathetic spike, however, must be dampened as much as possible to avoid vasovagal response and maximize treatment efficacy. One of the main things limiting the number of needles a patient can tolerate, which limits the amount of homeostasis we can induce, is the sympathetic nervous system elevating too much, too fast. This is what induces a vasovagal response. If we target the parasympathetics first, we use the reciprocal inhibitory connection between the two sides of the autonomic seesaw to depress the rate and duration of the initial sympathetic stimulus during needle placement. This makes treatment far more comfortable for patients, it allows them to tolerate more needles, and it allows us to treat more pathology and induce more homeostasis each visit.

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I want to push my patient’s autonomic nervous system as far in the parasympathetic direction as possible, as fast as possible, for about an hour, or so. The longer the needles are left in place, to a point, with the parasympathetics dominant, the more effective treatment is. The longer the brain has to respond to a stimulus, if said stimulus just so happens to induce homeostasis, we can use it to free the brain and body of the shackles placed upon them by the hyperactive sympathetic autonomic nervous system. When this happens, magical wizard-Healing takes place. This is good.

I see miraculous improvements and complete recovery from impairments typical treatments fail to change, sometimes for decades, on a consistent basis, including erectile dysfunction. The trick is treating the autonomic nervous system itself, rather than the specific impairment. If you are treating the nervous system itself, you will always be led to the area of primary complaint, the pelvic floor in the case of erectile dysfunction. However, only treating the pelvic floor to fix the pelvic floor is a common mistake that leads to less-than-optimal results. In the majority of erectile dysfunction cases, the pelvic floor and the penis are not causing themselves to dysfunction. Most stuff in our brain and body do not act on themselves. The parasympathetic-dominant innervation of the pelvic floor simply makes it a likely region to first exhibit notable functional impairment secondary to chronic sympathetic hyperactivity.

A thing I think about a lot, aside from fishing, is how crazy it is that dry needling combined with joint manipulation alone can resolve many idiopathic impairments, including erectile dysfunction, in isolation from other treatment and lifestyle changes. The primary underlying reasons most people’s autonomic nervous system is stuck in sympathetic hyperactivity are from poor diet (eating processed food), lack of exercise, lack of proper supplementation, and other individual factors. I spend as much time as needed with my patients and students discussing the life-altering importance of these subjects. Unfortunately, most people will not make significant changes in these areas. Even so, long-standing impairments like erectile dysfunction often completely resolve following thoughtful dry needling and manipulative treatments. When utilized properly, this treatment combination has enough of a homeostatic effect on the autonomic nervous system to return it to a state where it can once again self-regulate. I think of it as hitting the reset button, or running an antivirus program on a computer.

The sympathetic chain, which most anatomy and physiology books label from the stellate ganglion at the first rib to somewhere in the lumbar spine, is the primary controller of sympathetic autonomic function outside the brain. It has numerous plexuses branching off it that regulate our organ systems. Any stress on the chain directly amplifies sympathetic output. This is why I find it so vitally important to restore normal joint position following normalization of soft tissue. This is another reason to treat the entire body, not just the pelvic floor. Joints don’t move themselves, and you cannot have joint pathology without pathology of the surrounding soft tissues. If we are treating only joints, or only soft tissues, we are missing half the battle.

Any deviation of any vertebral segment is going to place abnormal stress on the sympathetic chain. Any abnormal stress on the sympathetic chain is going to increase sympathetic output. Any shortened, hypoxic piece of tissue throughout the body also increases sympathetic output. Subsequently, we need to think about removing as much tissue pathology throughout the body as possible, while at the same time directly targeting the parasympathetic portions of the autonomic nervous system, with the goal of bit-by-bit dragging the sympathetic side of the autonomic nervous system back down to a level where proper autonomic self-regulation is once again possible. Once this happens, dingalings stop deflating and peace is restored to the land.

Let me know if anyone has any questions about anything. This is truly a life-altering treatment for a large percentage of men suffering from this condition. Needlessly suffering.

Jason