Ask an expert - body - genitals / urology

19 questions

There is no doubt that the treatment which you have already been prescribed, oestrogen in pessary form, has been consistently shown to help prevent recurrent UTIs in post-menopausal women. As such, we would be unlikely to recommend acupuncture treatment as an immediate alternative, but there may be some scope in discussing with your GP what happens if the oestrogen brings the UTIs under control. Using acupuncture alongside the other treatment may improve the overall results and may facilitate a safe withdrawal from long term medication use.

Whenever we receive an enquiry we look through all the research databases to see what, if any, research exists. Most acupuncture research is undertaken in China and not translated, so restricted funding and the problems of assembling suitable cohorts of patients can mean not a great deal exists. However, there are two studies from Bergen in Norway


https://www.ncbi.nlm.nih.gov/pubmed/9612877

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447293/


which showed some very promising results. Both of these are cited on reviews of the treatment of recurrent UTIs, and the following two

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931387/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/

are worth a look because they spell out all of the options and are generally very positive about the treatment which you have been recommended to have.

There are obviously ways of treating UTIs from a Chinese medicine perspective; they are not a recent invention! The theoretical basis of Chinese medicine is entirely different, and the manner in which the condition presents will point to specific patterns of imbalance which may be reflected in other systemic problems. It is not often that a symptom stands in isolation, and our basic premise of treating the person, not simply the condition, tries to make sense of a symptom within its overall context. This can sometimes mean treating the overall patterns without specific reference to the individual problems, which can be quite confusing to a patient. However, if it works...!

Our one concern in cases like this is that people often get caught up with treatment regimes which it is quite difficult to unravel. The Trospium and Lansoprazole may not be entirely necessary if the oestrogen takes effect, but a practitioner would not be able to make that call, only the GP who prescribed them. This can make the clinical picture a little more confusing, but a properly trained practitioner will be able to assess the impact of medications on the system and allow for them.

Trospium is often prescribed for an over-active bladder, and if that is one of the manifestations of the UTIs you have been experiencing, there is some good evidence that acupuncture may have be of benefit. These three studies 

https://www.ncbi.nlm.nih.gov/pubmed/15994629

https://www.ncbi.nlm.nih.gov/pubmed/25399241

https://www.ncbi.nlm.nih.gov/pubmed/25033919

all make interesting reading.

However, the best advice that we can give is that you drop in to see a local BAcC member to discuss what may be best for you. Complex presentations are always best advised on face to face, and most of our members are very happy to give up some time without charge to prospective patients to ensure that acupuncture is the best option for their problems. This also gives you a good chance to meet them and see where they work before committing to treatment.

We are sorry to hear that you are experiencing what sound like very unpleasant side-effects from a treatment.

We are not sure from your email what the provenance of your practitioner is. The technique you describe is called percutaneous posterior tibial nerve stimulation, about which you can read here:

https://www.nice.org.uk/guidance/ipg362/chapter/1-Guidance

It is not really an acupuncture technique as such, at least it certainly is not a part of the ancient traditional Chinese medicine which we all practise. It is a modern technique using needles as electrodes which, as is often the case in modern developments of acupuncture, is described as working 'by a mechanism which is not yet properly understood.' It may well be that a traditional acupuncturist has decided to add this to their repertoire, but it is not a part of our core training.

As far as your strange symptoms are concerned, in conventional medicine it might be possible to make a case for some of the local ones, i.e. pain or tingling in the immediate area of the electrodes, because there may have actually been irritation of the nerves or small bruises which have consolidated to generate the symptoms from which you suffer. However, there would be very little that western medicine could do to explain why that should be generating sensations in your left arm and in your head.

From a traditional acupuncture perspective it might just be possible that the stimulation has had an effect on the channels of energy, and there are certainly internal connections between hand, foot and head which might explain what is going on. However, the mystery here would be what was causing the connection to be made several days after the treatment. If there are after effects or adverse effects after treatment they are generally immediate and subside within the first 48 hours. It is rather unusual for something to kick in three or fours days after the event and then to generate something which we call propagated needle sensation at this stage. This kind of effect takes a great deal of work to generate, and it is difficult to see what could be replicating this so long after a session.

Of course, we do have to bear in mind that there are sometimes occasions when a new symptom arises after, but not because of, a treatment. With four million treatments a year this can always be a possibility. The first thing we always advise, and what applies especially in your case, is to seek medical advice to find out exactly what is happening. This may take a referral to a neurologist, but since it sounds like a neurological effect getting advice here may well establish causation, i.e. whether the treatment actually caused what it happening. In an event this will point the way towards making it go away.

It might also be worthwhile talking to the practitioner about what they have done. They will know better than anyone else what points and techniques they have used, and may be able to make sense of what has happened to you.

It may be comforting to be aware that very few serious adverse events take place each year, and where these do happen from acupuncture treatment it is usually from penetration of an organ or direct physical damage. The remainder tend to be short-lived and transient, and we are confident that if this is really an effect of treatment it will subside relatively quickly. 



Q:  I've had a small epididymal cyst (spermatocele) in each testicle for a few years now and while they cause constant mild discomfort I'm hesitant to look into surgical options. I've been checked out by my GP and had diagnostics to rule anything else out.  Do you think acupuncture could be of help and, if so, would it likely just treat the symptoms, ie. the discomfort, or is there any evidence to suggest it could help shrink the cysts themselves?

A:  This is the first time we have been asked about epididymal cysts. We have trawled the research literature for any evidence of research trials but there is nothing of consequence except for a few studies of epididymitis, which isn't close enough to warrant citing. Even acupuncture sites do not offer a great deal. We suspect that there are probably Chinese studies, but only a minute fraction of these are translated each year.

However, from a Chinese medicine perspective all cysts are simply accumulations of fluid which indicate a weakness of flow, either in a specific channel of energy or more systemically in one of the Organs responsible for the free flow of fluids (note the capital letter - Organ in Chinese medicine is not the same as organ in western medicine). If this is the case, then there should be some clear diagnostic signs pointing to the weakness or imbalance, and a practitioner might feel fairly confident that this would point to a potential change.

Even were this not to be so clear cut, Chinese medicine was and remains premised on the simple belief that a system in balance corrects itself, and we have seen many many cases over the years where there has been no clear diagnostic patterns but where problems have been resolved, even sometimes when no-one in conventional medicine knew what they were. Quite disturbing when no-one, western or eastern, can tell you what you used to have, but in then end gone is gone.

However, the danger with treating problems like yours where there isn't a substantial volume of case work to show that it might resolve is that treatment can sometimes extend much longer than is warranted by the returns. It is very useful to have some kind of measurable outcomes, and to review any progress on a regular basis (every four or five sessions) to keep an eye on how much the treatment.

The first step, though, is to see a local BAcC member for a brief informal assessment of what may be possible. Most are more than happy to spare a few moments without charge to see whether there are clear diagnostic signs which would underpin a slightly more precise assessment than we can give at this range.


a:

A:  We are sorry to say that there is no evidence of which we are aware which would lead us to recommend acupuncture treatment to improve orgasmic response, either heightening existing response or addressing the problem of anorgasmia from which many women suffer. There are a number of studies for conditions affecting the genital area, like vulvodynia and vestibulodynia, and for the depressed sexual function in women taking specific anti-depressants

http://www.ncbi.nlm.nih.gov/pubmed/19912491

http://www.ncbi.nlm.nih.gov/pubmed/23790229

http://www.ncbi.nlm.nih.gov/pubmed/25639289

which report improvements in sexual function after the treatment, but the masking of pain or pathological changes brought on by the medication make this less noteworthy than might otherwise be the case. We suspect that you could probably show a similar correlation with the removal of severe toothache.

However, while there are no specific treatments whose provenance we can vouch for, there is no doubt that the ancient Chinese had a very clear view of normal sexual response and equally clear views about specific energetic changes which might have an impact on sexual function. This author has also heard of several case histories where injury, such as  tearing in childbirth with attendant surgery, has caused a serious reduction in sexual response, and where the blockage caused by the injury has been partly responsible.

The best advice that we can give is that you visit a BAcC member local to you and ask for the brief face to face chat where you can be more explicit about the nature of the problem and also the background to it. For reasons of common sense we would recommend that you talk to a female practitioner, but in the event of treatment being something which they recommend and which you choose to follow, you need to be aware that there are very few acupuncture points in intimate areas which might be brought into play, none which can be needled without the offer of a chaperone in the case of either sex, and none with which a patient is presented with as an option on the day. 

The theory of Chinese medicine is based on the flow of energy, or 'qi' as it is called, and in theory it may be possible that this area of the body is not as replete with qi as it should be. If there are energetic reasons for this, then acupuncture may offer a solution. However, our experience is that for many, if not all, of the patients we have seen with this problem there is usually a strong emotional and mental element which is beyond the scope of what we as acupuncture practitioners can address. 

Q:  I had a viral Infection in my right ear 3yrs ago. It affected my balance a lot, I had to lie down most of the day for about 3wks.My balance got better , but it left my ear deaf with a drone. As well as this I was suffering from candida overgrowth very bad. I think I have still got the candida , because the symptoms are still there. Would accupuncture help these in any way?

A:  We have been asked questions about candida infections before, usually when it has been brought on by antibiotics. Although the response we gave was geared to antibiotic causation, we think that the general points it made are worth repeating in full:

Can acupuncture help cure candida caused by taking many antibiotics? As you are no doubt well aware, there is still a great deal of controversy in the orthodox medical profession about whether candida constitutes a 'real' condition, and a great deal of sharp practice on the fringes of the alternative medicine profession selling people expensive remedies of doubtful provenance.

From a Chinese medicine perspective there are a number of issues which the practitioner would want to look at carefully. Chinese medicine is premised on the flow of energy, called 'qi', in the system whose balance and rhythms are integral to the well-being of the person. Many things can disrupt this flow, and western medications can be a major source of problems. However, when people say sight unseen 'antibiotics do x' or 'antibiotics do y' that is not really within the spirit of the system. Each person is a unique balance of energies, and how western drugs affect them can be very different. Obviously the Liver and Kidney (capitalised to denote the Organs as understood from a Chinese perspective) take much of the burden of processing medications, but if there is a pre-existing weakness anywhere in the system, this may be the weak point which is further weakened by the stress of the drugs, and the symptoms may not relate directly to specific Organs normally deemed to be under threat.

At the same time, the symptoms which someone has can point to under-performance in specific parts of the system, and if you have searched on google for 'acupuncture' and 'candida' you will often find reference to 'dampness', a form of imbalance within the system which can have both internal and external causes, and which often relates directly to the Spleen as understood in Chinese thought. This often leads to dietary recommendations as well as treatment.

However, we would recommend that your best course of action before committing to treatment is to visit a BAcC member local to you for a brief face to face assessment, hopefully without charge, to establish whether the presentation you have is best served by acupuncture treatment or not. There are some cases where it is clear that acupuncture may have a good effect, and others where there is no obvious direct connection between what someone is experiencing and an energetic weakness. This is not always a bar to treatment; the ancient systems treat the person, not the disease. However, where one can see a direct link, it is often easier to predict movement and change.

Candida is a very difficult condition which seems to arise against a more generalised backdrop of problems to do with stress, illness and lifestyle, and then causes
a fresh raft of these which in turn fuel the original problem. As with all medical approaches in these kinds of situations the key aim is to break the spiral and give the system time to recover. This can sometimes be very rapid, but in the case of candida our experience is that it can take time and usually involves acupuncture treatment as just a part of a broader treatment strategy involving diet, supplements and herbal or homeopathic treatment.

As we said in the earlier reply, however, there is almost a limitless supply of 'guaranteed to help' products, and while everything works for some people, there is rarely something which works for everyone. The best advice on diet and supplements will always come from someone properly trained to offer advice, and hopefully someone who is independent of any financial relationship to the products recommended. Our members tend to network locally, and most will know someone they trust to make a referral if required.

The noise in your ears is another matter. You may be lucky insofar as the background context of candida may mean that this is treatable as a part of the same overall pattern. However, noises in the ear, under the general heading of tinnitus, are very difficult to treat, and we have for many years advised people about not being too optimistic about the use of acupuncture for treating this. There are a couple of well-defined syndromes which might point to a rapid resolution, but in the majority of cases there seems to be very little conclusive evidence of a specific treatment which seems to work. Everything will work for someone, but there is rarely something which works for everyone. If you look at the tinnitus support group newsletters you will see this time and time again, a remarkable result for one person followed by dozens of other people trying the same solution without success.

The best advice we can ever give for conditions like yours, where the presentation really is unique to each individual patient, is to visit a BAcC member local to you for a brief face to face chat and assessment of what they think treatment may be able to offer you. We are sure that they will give you an honest answer and will try to direct you to the best possible treatment for you, even if this is not with them.

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