Dry Needling & Joint Manipulation for Erectile Dysfunction & Male Pelvic Health: A Quick, Cheap & Easy Fix for a Devastatingly Neglected, Widespread Problem

Before you vomit just considering a needle poking into your pelvic floor, which sounds about as fun as a swift kick in the junk, let me assure you, the pelvic floor structures are some of the most comfortable, painless needle locations in the body. I know this sounds counterintuitive, and it totally is, but I promise you, it is surprisingly pleasant. Remember, the needles we use are not hollow and are around 0.15 to 0.20 mm thick. A regular needle most people think about is hollow and somewhere between 1-2 mm thick. Trust me, I am typically the only guy in our pelvic floor classes, I get needled down there more than anyone I know. This weekend we have 11 female and zero male students, meaning I am the only male for all 11 girls to practice on. My wife Angela, who teaches with me, finds this endlessly amusing... Seemingly hoping I suffer painfully, but it never happens! I am serious, it is amazingly comfortable and awesomely effective.

Male pelvic dysfunction, including pain with sex, general pain, erectile dysfunction, incontinence and more, is one of the worst-treated cohorts of medical impairments in our country. The travesty of this is, the vast majority of all pelvic dysfunction, males and females, is 100% treatable and fixable, with the proper knowledge and skills. Unless you have significant underlying pathology, like spinal cord injury, morbid obesity, or advanced-grade prolapse, nobody, not a single dude, should suffer from pelvic health issues. Unfortunately, about 40% of men in their 40’s suffer from some type of ED. That number increases 10% per decade. 50% of 50-year-olds, 60% of 60-year-olds, etc. So why do so many men suffer from pelvic health dysfunction?

Well, the reasons are numerous. Here are the first five that come to mind:

Like with every other medical impairment, the pharmaceutical companies will do anything if it helps their bottom line. If you make money selling pills, actually curing people from pathology is not good for business.
The majority of physical therapists are female, and almost all pelvic health therapists are female. The world is full of insane, lawsuit-happy people, and treating the genital-area of the opposite sex, or the same sex, for that matter, increases legal liability from the cray crays. Less than 5% of our pelvic health classes students are male.
The American Physical Therapy Association (APTA) has 13 or so board certified specialties. Women’s health is one of them. Men’s health is nowhere to be found. Why is this?
Guys are bad, really bad, at talking about or seeking treatment for pelvic dysfunction.
Most medical professionals have no idea, or do not care, there is an easy cure for most pelvic health issues.

The long and short of it is this: Non-pharmacological male pelvic health treatment is basically nonexistent in this country and most other countries. This is sad, because the vast majority of all pelvic health issues, barring significant underlying pathology, are quickly, cheaply and easily fixable with a thoughtful combination of dry needling and joint manipulation.

Dry needling combined with joint manipulation is the best combination of tools on planet earth to normalize soft tissue and the autonomic nervous system (ANS) toward homeostasis. ANS homeostasis is the key to all health. Staying in good shape, eating well, and lifelong exercise, along with a regular dose of thoughtful dry needling and joint manipulation, keeps the ANS in relative homeostasis. If everyone would do this, we would dramatically lower overall medical impairment and medical costs nationwide. Most people don't stay in shape, eat well, or exercise. So let's focus on needling and manipulation, shall we?

If the soft tissues are normalized, but not the joint deviation the pathologic soft tissues caused, the persisting joint deviation will drive recurrence of pathology, and vice versa. It is impossible to maximally normalize the pelvic structures and the ANS to homeostasis without the use of dry needling and joint manipulation. Strength potential of the pelvic floor musculature is not the problem in the majority of pelvic health patients. The problem is, the muscles are neurologically inhibited from functioning optimally.

To build actual sarcomeres, muscle cells, in parallel and in series, making your muscles physically bigger, it takes at least 6-8 weeks of strenuous exercise to muscle failure about 3 times a week. How many PT patients get 24 visits of PT? None. Except maybe some surgical patients, and they are contraindicated for exercise for a lot of the time. Yes, people do get stronger quickly in PT, in under 6-8 weeks. Why is this, though? It’s not because your muscles are bigger. The impossibility of that, without steroids or something like that, is established science, at least at the moment. The reason muscles get stronger quickly, especially since most people never exercise and don’t move enough, is improved muscle length, improved neurovascular function, blood flow to soft tissues, and improved ANS homeostasis.

Dry needling combined with joint manipulation is a significantly faster, lasting way to improve neurophysiologic function and ANS homeostasis. Simply exercising patients only provides temporary relief, if it does not cause increased impairment, which it frequently does. If the problem is hyperactive sympathetics, ANS dysfunction, muscle shortening, tissue hypoxia, etc., strengthening already pathologic muscles oftentimes makes them worse, via further sympathetic stimulation, leading to increased SANS hyperactivity, blood pressure, blood glucose, blood flow restriction, hypoxia, and more. Don’t get me wrong, exercise is super important and all humans would be far healthier if they were in even passing physical condition. I have been in excellent shape and healthy my whole life, aside from being in a coma from malaria for 4 days in Central America. However, I like to live in reality. We know for a fact that most PT patients do not exercise outside the clinic and do not do their home exercise programs. Most people, in general, simply do not exercise. Ever. Nothing we do is changing human nature. So, what is forcing them to exercise for a month or so going to do for them? Long term? Nothing. Specifically targeting and normalizing the neuromusculoskeletal system (what dry needling and joint manipulation do best) however, provides long-lasting, awesome results. The most common comment I get from pelvic health patients is, wow, I can’t believe I wasted my time on those exercises in PT over the years when this was all I needed.

Remember: The vast majority of mental and physical impairments involve sympathetic autonomic nervous system (SANS) hyperactivity. Most problems, including mental and physical stress, trauma, etc., cause sympathetic hyperactivity. Know anyone who has mental or physical stress out there? One inevitably causes the other, given enough time. Chronic SANS hyperactivity causes peripheral vasoconstriction. SANS hyperactivity depresses the parasympathetic autonomic nervous system (PANS), leading to muscular shortening, hypoxia, and dysfunction secondary to numerous pathophysiologic mechanisms. All nine, or so, pelvic floor muscles are innervated by a parasympathetic-dominant portion of the autonomic nervous system (ANS), nerve roots S2-S4, to some degree or other.

Along with the pelvic floor, the parts of the ear innervated by the auricular branch of the vagus nerve (concha, cymba concha, inner tragus), the sacral periosteum around S2-S4, and the upper cervical / suboccipital periosteum, all parasympathetic dominant, should be targeted. Don't forget to add 1-2 Hz microcurrent connecting all of these locations to each other in various ways. This stimulates four times the amount of bioavailable beta endorphins. Endogenous opiods dampen pain, which by itself reduces sympathetic activity. They also regulate the ANS via numerous other, less well understood mechanisms. One of them being their direct release from some white blood cells.

Erectile Dysfunction (ED)

ED is a widespread impairment from which men needlessly suffer. Yes, Viagra and other similar pills do help. Viagra was initially tested as a blood pressure lowering medication. Blood pressure is lowered via SANS depression, PANS elevation, and ANS homeostasis. ED is primarily a muscular and blood flow problem. Again, there is no better treatment to normalize muscle function and blood flow, via ANS homeostasis, than a combination of dry needling and joint manipulation. These treatments address both the symptoms and the cause of ED. Viagra only addresses the symptoms of the problem. If the cause of a problem is never addressed, it never gets fixed. It’s no accident that almost zero medications address the underlying cause of the problem. Hence the page-long pill list most people over 40 have for life. So unnecessary and incredibly harmful. So many neuromusculoskeletal impairments are easily and cheaply fixable, without pills, including ED. It is shameful this knowledge is not readily available for the general public. Again, this is intentional.

To Achieve Erection:

Smooth muscle cells lining the arteries in the pelvic area need to relax to allow for vasodilation and increased blood flow, via PANS stimulation.
Blood must flow into the corporal sinuses and penis.
The bulbospongiosus and ischiocavernosus muscles, both located at the base of the penis, must be able to fill with blood and contract.
Remember, SANS hyperactivity is a vasoconstrictor. It limits blood flow to the genital muscles, making them hypoxic, hindering their contractile ability and strength.

To Maintain Erection:

The amount of blood and muscle function in the penis must be sufficient to pressurize the tissue to the point where the veinous channels and valves are passively closed.
Remember, veins and their valves can be closed off secondary to increased pressure around them. Arteries, with their smooth muscle lining, are much thicker and tougher and cannot be shut off without external pressure, like a blood pressure cuff.
The amount of blood entering the penis must be greater than the amount leaving. If more blood is leaving than arriving, you get a deflated dingaling. This is not ideal…

Difficulty gaining an erection and maintaining it are nervous systems, blood flow, and muscular impairments. There is no better method to normalize and improve blood flow and muscular function, via ANS homeostasis, than the combination of dry needling and joint manipulation.

Pain with Sex, Incontinence, General Pain & More

I cannot stress this enough, unless there is significant neuromusculoskeletal structural pathology, nobody should have incontinence, pain with sex or general pelvic pain, ED, or other dysfunction. Almost all pelvic health impairments, both men and women, are easily fixable with the proper knowledge and tools; dry needling and joint manipulation. Without these treatments, many never resolve their problems, even if they are being actively treated.

At a certain chronicity of SANS hyperactivity, the human body often simply stops responding to indirect treatment. Anyone with a bad case of epicondylitis, headaches, or plantar fasciitis knows what I am talking about. No matter how much you try to get it to go away, it always comes back. Wait, my wife Angela always says she tries to give me away… must be a sign of love… Anyway, there is no direct treatment of any tissue in the body, aside from the skin, without the use of needles. And, if you do needle, but do not manipulate the joints to neutral following soft tissue normalization, or vice versa, patients will not achieve maximal ANS homeostasis or resolution of impairment.

Another problem with the pelvic floor muscles is their location and orientation make them almost impossible to stretch. If muscles are left in a shortened position, they develop trigger points, get shorter, compile excessive concentrations of pain-amplifying substances, become hypoxic, weak, hurt, dysfunction, sympathetics elevate more, and the negative feedback loop continues. Once again, all of these processes stem from SANS hyperactivity. Thoughtful dry needling combined with joint manipulation are the most powerful tools we have for normalizing soft tissue, joints and the ANS.

I cannot tell you how many guys, of all ages, who have had pelvic health impairments for years to decades, experience full resolution of symptoms, permanently, within a handful of treatment sessions. Many of these guys have attempted standard treatment in the past, with little to no success. The most powerful aspect of dry needling combined with joint manipulation is their awesome regulatory effect on the ANS. The mechanisms of regulation toward ANS homeostasis are legion. There is no other treatment that holds a candle to the immense homeostatic, healing power of thoughtful needling combined with joint manipulation. Male pelvic health should be a non-issue for over 90% of men that are currently suffering from these impairments.

If anyone would like to attend a class, needs any help with treatment strategies or finding someone we have trained to treat you, let me know. My contact information is on the website.

Check out some of my articles on ANS regulation:
- How to Limit Initial Sympathetic Autonomic Stimulation and Avoid Vasovagal Response
- Controlling Autonomic Sympathetic Hyperactivity with Dry Needling and Quantum Homeostasis

Intricate Art Spine & Body Solutions and its affiliates are not responsible for any injury or damage that may result from the use of techniques taught or information being provided. This content is provided for informational purposes only and by participating you are doing so at your own risk.

References

Ferrini, M.G., Gonzalez-Cadavid, N.F. and Rajfer, J., 2017. Aging related erectile dysfunction—potential mechanism to halt or delay its onset. Translational andrology and urology, 6(1), p.20.
Wang, J.S., Deng, S., Zhao, Q., Zhang, K.G., Bao, B.H., Feng, J.L., Meng, F.C., Dai, H.H., Li, X., Li, H.S. and Wang, B., 2021. A Bioinformatic Investigation of the Mechanism Underlying Migraine-Induced Erectile Dysfunction. BioMed Research International, 2021.
Wang, H., Zhao, M., Zhang, J., Yan, B., Liu, S., Zhao, F., Guo, J. and Wang, F., 2022. The Efficacy of Acupuncture on Patients with Erectile Dysfunction: A Review. Evidence-Based Complementary and Alternative Medicine, 2022.
Wang, J., Zhou, Y., Dai, H., Bao, B., Dang, J., Li, X., Wang, B. and Li, H., 2019. The safety and efficacy of acupuncture for erectile dysfunction: A network meta-analysis. Medicine, 98(2).
Evren, I., ÖZTEKİN, İ., Atayoglu, A.T. and BUCCHOLZ, N., 2021. Comparison of Medical Treatment and Acupuncture in Treatment of Psychogenic Erectile Dysfunction: a Prospective, Randomized, Placebo-Controlled Study. International Journal of Traditional and Complementary Medicine Research, 2(3), pp.121-125.
Lai, B.Y., Cao, H.J., Yang, G.Y., Jia, L.Y., Grant, S., Fei, Y.T., Wong, E., Li, X.L., Yang, X.Y. and Liu, J.P., 2019. Acupuncture for treatment of erectile dysfunction: a systematic review and meta-analysis. The World Journal of Men's Health, 37(3), p.322.

blog