Needles and Nerves: Trial Puts Electroacupuncture to the Test Against Post-Prostatectomy Erectile Dysfunction

For the tens of thousands of men who undergo robotic-assisted radical prostatectomy each year, the removal of a cancerous prostate often comes at a hidden cost: the nerves that thread alongside the gland and carry the signals for an erection are frequently stretched, heated, or sacrificed in the process. Even with the precision of robotic surgery, erectile dysfunction remains one of the most common and distressing sequelae of the operation, eroding quality of life long after the cancer itself has been conquered. Now, a team of researchers at West China Hospital of Sichuan University has designed a rigorously controlled trial to test whether an ancient technique, supercharged with modern electrical stimulation, can help these men recover. The study protocol, published in BMC Complementary Medicine and Therapies, describes a randomized, sham-controlled trial of electroacupuncture for erectile dysfunction in prostate cancer survivors after robotic-assisted radical prostatectomy.

Electroacupuncture is a refinement of conventional acupuncture in which fine needles inserted at specific points on the body are connected to a device that delivers a controlled electrical current. The stimulation is thought to modulate nerve activity, enhance local blood flow, and trigger the release of endogenous signaling molecules, mechanisms that have made the technique a popular option for managing erectile dysfunction in China, where it is widely employed in clinical practice. Yet popularity is not proof. The authors of the protocol are candid about the problem: robust evidence supporting the efficacy of electroacupuncture specifically for erectile dysfunction after robotic prostatectomy remains scarce. Most existing studies are small, unblinded, or lack credible control procedures, leaving clinicians and patients alike without a trustworthy answer to a simple question: does it actually work?

The new trial is designed to answer that question with unusual methodological discipline. A total of 114 participants will be enrolled and randomized in a one-to-one ratio to receive either real electroacupuncture or a sham electroacupuncture procedure that mimics the sensory experience of treatment without delivering the same therapeutic stimulation. All participants, regardless of assignment, will undergo 24 treatment sessions spread over eight weeks, a schedule intended to deliver a meaningful cumulative dose of therapy while remaining practical for patients to complete. After the treatment phase ends, the researchers will follow every participant for an additional eight weeks to see whether any benefits persist, fade, or continue to accumulate once the needles are set aside.

The choice of a sham control is central to the trial’s credibility. Acupuncture trials are notoriously vulnerable to placebo effects, because patients inevitably know whether they are being needled. To blunt that bias, the researchers will use a sham procedure modeled on devices such as the Park Sham Placebo Acupuncture Device, a blunt, retractable needle that gives the sensation of penetration without actually piercing the skin in the same way, combined with electrical stimulation parameters designed to feel similar without engaging the same neural pathways. If patients in both arms report comparable sensations but only the real-treatment group improves on objective measures, the case for a genuine biological effect becomes far stronger than in trials that compare acupuncture against no treatment at all.

The primary outcome is the score on the International Index of Erectile Function, a five-item questionnaire widely regarded as the standard patient-reported measure of erectile function in clinical research. Known as the IIEF-5, the instrument asks men to rate aspects of their erectile ability, including confidence in achieving and maintaining erections and the satisfaction derived from intercourse. Changes in this score will serve as the trial’s headline result, but the investigators have cast a much wider net. Secondary outcomes include the Erectile Hardness Scale, which grades the rigidity of erections on a simple ordinal scale; questions two and three from the Sexual Encounter Profile, which capture whether an erection was achieved and whether it was hard enough for penetration during real-world encounters; and a visual analogue scale on which patients rate their own subjective sense of improvement.

What distinguishes this protocol from many acupuncture trials is its commitment to objective physiology. At baseline, week eight, and week sixteen, participants will provide serum samples for testosterone measurement, allowing the researchers to determine whether electroacupuncture influences the hormonal axis that underpins male sexual function. At the same time points, they will undergo assessments of penile hemodynamic parameters, the measurements of blood flow and vascular response that reveal whether the physical machinery of erection is actually recovering. Because erection is fundamentally a vascular and neurological event, these physiological endpoints could expose mechanisms that questionnaires alone cannot. If testosterone levels and penile blood flow shift in parallel with symptom scores, the trial will offer not just an efficacy verdict but a window into how the therapy might work.

The psychological dimension of post-surgical sexual recovery is also built into the design. Erectile dysfunction after prostate cancer surgery is rarely an isolated physical problem; it is entangled with anxiety, depression, and a diminished sense of masculinity that can strain relationships and delay help-seeking. The investigators will therefore administer the Hospital Anxiety and Depression Scale at baseline and at weeks four, eight, twelve, and sixteen, alongside the other questionnaire-based outcomes. Tracking mood over the same timeline as erectile function may reveal whether restoring sexual health lifts psychological well-being, or conversely whether treating anxiety is a prerequisite for physical recovery, questions that matter enormously for designing rehabilitation programs that treat the whole patient rather than a single symptom.

Statistical rigor receives equally careful attention. The protocol specifies that all analyses will adhere to the intention-to-treat principle, meaning that every randomized participant will be analyzed in the group to which they were assigned, regardless of whether they completed the full course of sessions. This approach preserves the balance achieved by randomization and guards against the inflated estimates that arise when only compliant patients are counted. The trial has been registered on the International Traditional Medicine Clinical Trial Registry under registration number ITMCTR2025001479, has received ethics approval from the Institutional Review Board of West China Hospital of Sichuan University under permission number 2024-1606, and will be conducted in accordance with the Declaration of Helsinki, with informed consent obtained from all participants. The work is funded by the National Key Research and Development Program of China and a Regional Innovation and Cooperation Project of the Science and Technology Department of Sichuan Province, with the funders playing no role in the study’s design, conduct, or reporting.

The stakes extend well beyond one clinic in Chengdu. Prostate cancer is among the most common cancers in men worldwide, and robotic-assisted radical prostatectomy has become a dominant surgical approach in high-income health systems, prized for its precision and faster recovery. Yet nerve-sparing techniques, however skillfully executed, do not guarantee preserved erectile function, and the pharmacological mainstays of treatment, the phosphodiesterase-5 inhibitors that many patients know by their brand names, do not work for everyone, particularly men whose nerve pathways were damaged during surgery. A validated non-pharmacological option would fill a genuine gap in post-surgical rehabilitation, offering an alternative for patients who cannot tolerate medication, who prefer to avoid it, or who simply do not respond to it. The authors note that if electroacupuncture proves effective, the findings would support its integration as a viable non-pharmacological option within post-surgical rehabilitation protocols.

For now, the appropriate stance is cautious anticipation. This publication is a study protocol, not a result; no patient has yet been treated and analyzed under its design, and the trial’s findings will only become meaningful once recruitment, treatment, and follow-up are complete. But the protocol itself is a signal of how complementary medicine research is maturing. By pairing a traditional technique with a sham-controlled design, objective vascular and hormonal endpoints, intention-to-treat analysis, and prospective trial registration, the West China Hospital team has built the kind of study that can genuinely move the field, whatever the outcome. If the results are positive, they could reshape rehabilitation after one of the most common cancer surgeries in the world. If they are negative, they will spare countless men an ineffective therapy and redirect research toward approaches more likely to help. Either way, the answer will be worth far more than the question cost.

Subject of Research: Electroacupuncture as a treatment for erectile dysfunction after robotic-assisted radical prostatectomy

Article Title: Electroacupuncture for erectile dysfunction in patients after robotic-assisted radical prostatectomy: study protocol for a randomized controlled trial

Article References: Li, J., Chen, Y., Yang, L., Wen, Q., Lv, J., Liu, Z., Liu, L., Li, N., Lu, L., & Dong, Q. (2026). Electroacupuncture for erectile dysfunction in patients after robotic-assisted radical prostatectomy: study protocol for a randomized controlled trial. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05616-8

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05616-8

Keywords: electroacupuncture, erectile dysfunction, robotic-assisted radical prostatectomy, prostate cancer, randomized controlled trial, sham acupuncture, IIEF-5, testosterone, penile hemodynamics, acupuncture, urology, rehabilitation