Ask an expert - body - genitals / urology

17 questions

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.

Q: Two years ago I had phenol injected (by mistake) into my prostate (meant for haemorrhoids) with devastating consequences. The chemicals destroyed the prostatic nerves responsible for erectile function and caused permanent prostatitis - I am hopeful that the nerves will regenerate - do you think acupuncture may help? 

 A:  We have to be honest and say that the likelihood is very low. There is a considerable amount of research into the use of acupuncture, and especially electro-acupuncture, on animals, what our colleagues refer to sometimes as 'ratpuncture'. Whether these results are transferable to human beings is a huge question anyway, but such research as there is tends to be on the regeneration of peripheral nerves. There seem to be some possibilities that this can occur naturally in humans too, but deeper nerves within the trunk do not often show signs of regeneration. In the language of modern marketing, once it's gone it's gone, especially if there has been a clear pathway of causation, as is the sad case for you.

That does not mean that we would say categorically that acupuncture cannot help to a small degree. A great deal depends on whether the nerves were actually destroyed or largely inactivated. Normally the conventional medical use of phenol as a nerve block destroys rather than simply inactivates, but if a small proportion of the nerves remain but have been 'shocked' by the attempted murder there may be a minute chance that acupuncture treatment could have an effect. We would say, though, that this is highly unlikely.

There would be nothing lost in contacting a BAcC member local to you to see what they might make of the situation on the basis of a brief face to face assessment, but we would recommend that if you go down this route you check with the practitioners whom you contact who is the most experienced living and working in your area. This is not the time for the optimism of the newly graduated who sometimes believe that anything is possible. You probably need to see a seasoned veteran who will not excite expectations which cannot be met.

Thursday, 16 April 2015 00:00

Can acupuncture help with an irritable bladder?

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Q: I have seen a urologist who says i have an  irritable bladder.   Can acupuncture help with symptoms of frequency?

A: We have been asked this question a few times over the past two years, and one of the answers we gave to a similar question was:

Can acupuncture alleviate symptoms of an irritable bladder?

Q:  I have been diagnosed with an irritable bladder. Can acupuncture alleviate my symptoms, which is an urgent need to urinate.

 A: As our factsheet shows 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/urinary-incontinence.html

there is some evidence to suggest that urgency of urination can be helped by acupuncture, although there is not yet anywhere near enough evidence to make substantive claims here. If you search the internet there are a number of studies such as this one

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

which offer some hope.

However, we have to remind ourselves sometimes that Chinese medicine has been dealing with problems like this for over 2000 years, and has a very sophisticated process for understanding patients' symptoms against a backdrop of an entirely different conceptual framework. The understanding of the body as a system of energy, 'qi', in flow and the concepts of yin and yang to describe its flow and inter-relationships is very alien to the western ear. However, the rather wider understanding of organs as functional units with effects on body mind and spirit, and the underlying premise that symptoms are alarm bells, not the problem itself, can sometimes offer possibilities for understanding a problem in a far wider context. This will often be corroborated by other problems which a patient suffers and by diagnostic signs which the practitioner sees, and can often lead to a situation where a practitioner can tell the patient about symptoms that they haven't yet mentioned. If the problem is a part of a recognised syndrome or pattern of symptoms a practitioner will be able to give a clear idea of prognosis. Even if it doesn't the attempt to re-establish balance in the system can also have an effect on individual symptoms.

We recommend that you talk to a BAcC member local to you an ask for their advice in a brief face to face consultation whether they think that they can help you. We trust that they will give you an honest assessment, and refer you on to other modalities of treatment if they felt that these offered a better prospect of success.

We have had another look at the research evidence which has emerged since we wrote this response, and there are two more papers which make encouraging noises

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

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

and evidence of a systematic review about to take place. This is a survey of all papers on the subject which is regarded very highly within conventional medicine since it irons out anomalies in smaller samples.

One of our members has studied this problem for several years and given presentations at our research gatherings and conferences, so we are confident that there is something of importance emerging in the use of traditional acupuncture in this field. However, each individual person is different, however similar their symptoms may be, and the strength of Chinese medicine is that treatment is tailored to the unique needs of the patient, not simply offered as a one size fits all option. Visiting a BAcC member local to you would seem to us to be your best option. Here you will get advice for your own unique presentation.  

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