An acupuncture protocol for the treatment of erectile dysfunction (ED) - a Delphi-process.

INTRODUCTION Erectile Dysfunction (ED) is a widespread disorder, and the worldwide incidence is rapidly increasing. Acupuncture, an intervention out of the spectrum of Traditional Chinese Medicine (TCM) has a long tradition as treatment for ED. Nonetheless, a best practice treatment protocol is currently missing. A recent systematic review and meta-analysis confirmed a huge diversity of acupuncture treatments for ED and concluded that there is an urgent need to standardize acupuncture treatment for ED. Consequently, the authors conducted a Delphi process with the aim to achieve an expert consensus as a basis for the development of a best practice protocol. METHODS The Delphi process consisted of four rounds of questionnaires with closed and open-ended questions. Eleven acupuncture experts participated. The therapeutic aim was defined as "to achieve an erection sufficient for sexual satisfaction". RESULTS Consensus was achieved on 24 acupoints corresponding to 12 TCM syndromes. The syndromes were KI Yang xu, KI Yin xu, KI Qi xu, Ki and HT not harmonised, LR Qi Stagnation, LR Qi stagnation and Heat, Liver Blood xu, Liver Blood xu and Liver Qi stagnation, Damp-heat sinking to the lower Jiao5, HT and GB Qi xu, SP xu and HT Blood xu, Yin xu. The suggested optimal dose was between11-15 treatments given once or twice a week. CONCLUSION An expert consensus-based, semi-standardized best practice treatment protocol for the treatment of ED was developed. Moreover, the Delphi process also revealed inconsistencies as to which signs and symptoms constitute a TCM syndrome. Further Delphi studies including a broader range of experts from various acupuncture traditions are needed to establish further agreement. Nonetheless, the best practice protocol introduced in this paper provides a first point of departure for the implementation of a more standardized treatment approach. Moreover, since a recent meta-analysis concluded that more high-quality clinical studies on the topic are needed, this paper provides a first standardized acupuncture treatment protocol for ED.