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Acupressure as an Effective Method for Improving Sexual Function in Depressant Women Treated with Selective Serotonin Reuptake Inhibitor: a Randomized Clinical Trial

Nazir Hashemi Mohammad-Abad1 , Sahar Zafari2 , Seyed-Abdolvahab Taghavi2,* , Fatemeh Zafari2 , Elahe Karimi2 , Arezoo Hosseini2 , Fatemeh Rezaei2 , Marcello Iriti3 , Fatemeh Bazarganipour4,*

1Department of Psychiatry, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
2Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
3Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
4Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran

Correspondence to:
Seyed-Abdolvahab Taghavi
Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
E-mail vahab.taghavi@gmail.com

Fatemeh Bazarganipour
Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
E-mail f.bazarganipour@gmail.com
Received: March 11, 2024; Revised: March 31, 2024; Accepted: November 26, 2024

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

J Acupunct Meridian Stud 2024; 17(6): 196-205

Published December 31, 2024 https://doi.org/10.51507/j.jams.2024.17.6.196

Copyright © Medical Association of Pharmacopuncture Institute.

Abstract

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Importance: Sexual dysfunction in individuals suffering from depression may be both a symptom of the disorder and a side effect of antidepressants. To date, and to our knowledge, no randomized controlled trials have demonstrated the effectiveness of acupressure on sexual function in women of reproductive age who take antidepressants.
Objective: This study aims to evaluate the effect of acupressure on sexual function in women of reproductive age taking Selective Serotonin Reuptake inhibitors (SSRIs).
Methods: A randomized clinical trial with a control group. In total, 115 women taking antidepressants and suffering from sexual dysfunction were recruited from Shahid Rajaee Hospital in Yasuj, Iran. They were enrolled based on the inclusion criteria and were randomly assigned to either the acupressure (intervention) or control group. Pressure was applied to subjects in the intervention group at the PC6 and SP6 acupoints, and at placebo points P1 and P2 in the control group. Treatments were administered in a sitting position, twice weekly, for two months. Sexual function was assessed using the Female Sexual Function Index at baseline and after the eight-week intervention period.
Results: The acupressure group showed significant improvements in desire, orgasm intensity, satisfaction, and total sexual function score compared with the control group (p< 0.05).
Conclusions and Relevance: This study provides important evidence for supporting the use of acupressure at these specific points to improve sexual function in women taking SSRIs. Acupressure may be a practical and effective intervention for mitigating antidepressant-induced sexual function.

Keywords

Acupressure, Female sexual function, Selective serotonin reuptake inhibitors

INTRODUCTION

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Depression is the fourth most prevalent disorder in the world and accounts for the largest share of non-fatal disorders [1]. Individuals with depression often experience persistent feelings of numbness, hopelessness, helplessness, worthlessness, and guilt, leading to a loss of interest in life, work, and other previously enjoyable activities, including sex [2].

The most common treatments for depression are antidepressants known as selective serotonin reuptake inhibitors (SSRIs). However, while effective, SSRIs have been associated with side effects including nausea, sweating, tremors, dry mouth, insomnia, constipation, diarrhea, loss of appetite, and sexual dysfunction [3]. The incidence of sexual dysfunction in SSRI users ranges between 50% and 90% and includes symptoms such as erectile dysfunction, reduced libido, delayed orgasm, and pain during intercourse [4].

Sexual dysfunction in individuals with depression can be viewed both as a manifestation of the depression itself and as an adverse effect of antidepressant treatments [5,6]. When patients experience side effects, they often discontinue treatment, meaning that their symptoms continue [7]. Pharmacological treatments to eliminate these side effects include sildenafil, bupropion, tadalafil, and yohimbine. However, they can cause additional undesirable side effects such as hypotension [8,9].

Given the rising interest in complementary and alternative medicines in various fields of medical science, one promising approach is acupressure, a technique rooted in traditional Chinese medicine, with a 3000-year history [10,11].

Acupressure is widely used to treat and relieve various diseases and is based on acupuncture. However, instead of using needles, pressure is exerted on specific points on the body, which is believed to stimulate the flow of vital energy (qi), circulating throughout the body via channels called meridians. Disruption of the energy balance in the meridians leads to disease, and applying acupressure to specific areas improves the flow of qi, restoring the balance and ultimately curing the disease. Studies have shown that acupressure restores vital energy to blocked systems, and the World Health Organization has confirmed its therapeutic efficacy, particularly in activating neuroendocrine and immune mediators that play a significant role in sexual function [12,13].

Given the high prevalence of depression and its negative impact on sexual function, combined with the lack of studies conducted on the treatment of sexual disorders caused by antidepressants, this study aims to explore whether acupressure can improve sexual function in women of reproductive age taking SSRIs.

METHODS

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1. Design and data collection

This study was a double-blind randomized clinical trial undertaken at Shahid Rajaee Hospital, Yasuj University of Medical Sciences, Yasuj, Iran in 2021. Both the participants and the analysts were unaware of the group assignments. The study was approved by the Ethics Committee of Yasuj University (Ref. no. IR.YUMS.REC.1399.159), and written informed consent was obtained from all participants. The trial was prospectively registered with the Iranian Registry of Clinical Trials (www.irct.ir), under registration number IRCT20160524028038N10.

Randomization was performed using a simple randomization method, with the allocation sequence generated by the Computer Random Generation program. Participants were assigned to either the intervention or control group using coded, non-transparent sealed envelopes.

The sample size was determined using Khamba et al.’s [14] method requiring a minimum of 60 participants per group. The following formula was used:

N=Z1−α2+Z1−β2S12+S22Δ2
1−α=%95    β=%80Z is the value from the table of probabilities of the standard normal distribution for the desired confidence level (e.g., Z = 1.96 for 95% confidence)S1=76.45      S2=113.45      Δ=(185.59−136.18)

2. Recruitment of participants

Inclusion criteria were as follows: women aged 18 to 45 years, able to read and write, with a Hamilton Depression Rating Scale (HDRS) score of less than 18, and a diagnosis of mild to moderate depression. Participants were required to have been on at least four weeks of antidepressant treatment that was affecting sexual function, be married in accordance with Iranian law (which prohibits sex outside of marriage), and have a sexual partner present at least 50% of each month. Additionally, participants had to be two hours postprandial. Exclusion criteria included the presence of infectious or skin diseases, acute rheumatoid arthritis, wounds or skin infections at the acupressure site, speech or hearing problems, alcohol addiction or consumption, pre-existing sexual dysfunction, bereavement (loss of a close friend or relative) in the past six months, and chronic conditions such as cardiovascular, thyroid and kidney disorders, arthritis, diabetes, and epilepsy.

3. Description of intervention

The acupressure intervention was conducted by the main researcher (F.Z) who holds an acupressure certification. The investigator received training in acupressure techniques from a Traditional Chinese Medicine (TCM) professor over five instructional sessions conducted across one month. After obtaining written consent from the eligible participants, the subjects were evaluated over a two-month period.

At baseline (time 0, before the intervention), the following parameters were assessed: sexual function using the female sexual function index (FSFI), marital satisfaction via the Enriched Marital Satisfaction Scale, severity of depressive symptoms using the HDRS, and sexual satisfaction with the Larson Sexual Satisfaction Questionnaire. After completing the questionnaires, the subjects were randomized into either the intervention (acupressure) group or the control group.

In the intervention group, pressure was applied to the PC6 and SP6 acupoints, while in the control group, placebo points (P1 and P2) were used. The PC6 and SP6 acupuncture points were chosen based on previous reference publications as part of the female sexual dysfunction protocol and are known for their potential to alleviate depressive disorders [14,15].

For the intervention, participants were instructed to lie down on a bed, fully relaxed, to receive acupressure. The PC6 acupoint is located 2 cm above the transverse fold of the wrist, along the path of the median nerve, between the long tendons of the palm and the flexor of the elbow (Fig. 1A). The SP6 acupoint is located four finger-widths above the inner ankle, behind the posterior edge of the tibia (Fig. 1B). The P1 placebo point is located between the third and the fourth toes, outside the meridian line (Fig. 1C) [16], while the P2 placebo point is located at the junction between the second and third fingers of the hand, and is also outside the meridian line (Fig. 1D).

Figure 1.Location of points. (A) P6 acupoint, (B) SP6 acupoint, (C) P1 placebo point, and (D) P2 placebo point.

In both groups, each acupoint was pressed for 10 minutes, resulting in a total of 20 minutes of pressure application. Pressure was applied in a harmonized manner, one minute clockwise and one minute counterclockwise, followed by a two-minute rest period during which the researcher massaged the acupoint to maintain meridian stimulation. Pressure continued until the participant reported mild discomfort, whereupon pressure application was stopped.

The investigator also demonstrated the appropriate amount of pressure to be applied based on the amount of nail color change at the pressure points [17-19]. Additionally, the researcher instructed the participants on the self-administration of pressure.

Both the intervention and control groups received one acupressure session performed by the researcher, with subsequent training for the participant. The participants were then instructed to conduct three additional sessions in the clinic under the researcher’s supervision. Following this, participants were trained to perform acupressure at home, with a total of twelve sessions performed twice a week with either acupressure or placebo pressure points. The intervention group was also provided with information on acupressure points and how to apply pressure.

It should be noted that participants were positioned supine in the clinic to minimize hypotension and dizziness. At home, the procedures were performed in the sitting position, to minimize hypotension and to ensure comfort during self-administration [18,19]. Pamphlets and videos explaining the placebo pressure points and application techniques were provided to the control group. The researcher also reminded participants about their intervention schedule and follow-up appointments by phone and text message. The duration of the intervention for both groups was two months.

4. Outcome measures

Demographic data, comprising age, education, occupation, weight, height, and reproductive history were collected from all participants.

Sexual function was defined as any impairment of sexual desire and arousal, dyspareunia, and/or orgasmic dysfunction. The FSFI questionnaire, developed by Rosen et al. [20], was used to evaluate sexual function over a four-week period. This 19-item questionnaire assesses six independent dimensions of female sexual function: sexual desire (4 items), arousal (4 items), lubrication (4 items), orgasm (3 items), satisfaction (3 items), and pain (3 items). The answers are rated from 0 to 5, with higher scores indicating better sexual function [20]. The FSFI has been validated for use in Iran [21].

Marital satisfaction was assessed using the Enrich Marital Satisfaction Scale, which contains 47 questions scored on a 5-point Likert scale (1-5). For the first time in Iran, Soleymanian et al. [22] designed a 47-item form of this questionnaire. A higher score indicates greater marital satisfaction. The questionnaire has also been validated in Iran [22].

Sexual satisfaction was assessed by the Larson questionnaire, which consists of 25 questions. Responses range from never (1) to always (5), with higher scores indicating greater sexual satisfaction. The Larson questionnaire has also been validated in Iran [23,24].

In this study, the severity of depressive disorder was assessed using the 21-item Persian version of the HDRS, which includes various psychometric indices. This scale evaluates a range of depression-related symptoms such as low mood, suicidality, irritability, tension, loss of appetite, lack of interest, and somatic symptoms. Responses are recorded using 3-, 4-, and 5-point Likert scales. For example, for the item “insomnia early,” the scoring was as follows: 0 = no trouble sleeping; 1 = occasional sleep difficulties (i.e., taking longer than 30 minutes to fall asleep); and 2 = frequent sleep difficulties every night. Higher scores indicate more severe depressive symptoms [25]. The reliability and validity of this scale have been confirmed in Iran [26].

The research variables were measured at baseline (week 0) and after the intervention (week 8).

5. Data analysis

Patient data were entered into SPSS version 21 statistical software. Descriptive statistics (mean, standard deviation, frequency distribution) and inferential statistics (independent t-tests and paired t-tests) were used for normally distributed variables. Non-parametric tests (e.g., the Mann-Whitney U test) were used for non-normally distributed variables. Our analysis adhered to an intention-to-treat approach, incorporating all participants in the groups to which they were randomly allocated. A p-value of ≤ 0.05 denoted statistical significance.

RESULTS

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1. Sample characteristics

A total of 145 participants were initially enrolled, with 130 randomly assigned to two groups (65 in each group). Of these, 115 participants completed the follow-up (58 and 57 participants in the intervention and control groups, respectively). Participant allocation is shown in Fig. 2.

Figure 2.Flow diagram of patient’s enrolment and study progress.

Fig. 2 also shows that four participants in the intervention group and six participants in the control group discontinued the intervention due to concerns about potential adverse effects or because they believed that the treatment was ineffective. Therefore, outcomes for these participants were not included in the analysis. There were no significant differences in socio-demographic characteristics (Table 1), sexual function, marital satisfaction, or sexual satisfaction scores between the two groups prior to the intervention (p > 0.05). Therefore, attrition bias is unlikely to have affected the exposure or outcome. Because the findings related to the outcome in these individuals are not available, only data from the 58 participants in the intervention group and the 57 participants in the control group were analyzed as there was no crossover.

Table 1 . Demographic characteristics

VariableGroupsp-value
Intervention group (n = 58)Control group (n = 57)
Female age (years)*37.41 ± 5.7737.7 ± 6.240.79
Husband age (years)*42.63 ± 7.9844.1 ± 8.730.32
Weight (kg)*79.25 ± 11.0877.01 ± 10.060.25
Height (cm)*162.98 ± 4.52162.38 ± 5.190.5
Gravid*2.66 ± 1.982.61 ± 1.980.89
Parity*2.15 ± 1.642.15 ± 1.680.95
Occupation†0.48
Employee9 (15)13 (21.7)
Housewife51 (85)47 (78.3)
Education*10.61 ± 4.4910.7 ± 4.230.91

*Mean ± SD = t-test; †N (%) = X2.

2. Comparison of depressive disorder severity scores between the groups

The results shown in Table 2 indicate a significant improvement in the severity of depressive symptoms in the intervention group compared with the control group (p = 0.05). Additionally, the paired t-test results revealed significant differences in depressive disorder severity before and after the intervention in both the intervention (p = 0.05) and control groups (p = 0.05).

Table 2 . Comparison of sum score of depressive disorder between group

Variable*GroupTime
BeforeAfterp-value‡
Hamilton Depression Rating Scale scoreIntervention group (n = 58)20.59 ± 3.1712.91 ± 5.900.05
Control group (n = 57)19.81 ± 5.7516.52 ± 9.450.05
p-value†0.690.05

*Mean ± SD; †independent t-test; ‡paired t-test.

3. Comparison of sexual function scores between the groups

Table 3 shows that sexual desire, orgasm intensity, satisfaction, and total sexual function scores were significantly higher in the intervention group compared with the control group (p < 0.05).

Table 3 . Comparison of dimensions of sexual function before and after intervention in the study groups

Variable*Groupp-value†
Intervention group (n = 58)Control group (n = 57)
DesireBefore4.32 ± 1.014.41 ± 1.060.2
After5.07 ± 0.814.66 ± 0.840.05
ExcitementBefore2.77 ± 1.452.33 ± 1.40.68
After3.10 ± 1.032.8 ± 1.10.14
LubricationBefore3.33 ± 1.653.02 ± 1.690.99
After3.46 ± 1.623.07 ± 1.650.06
OrgasmBefore3.99 ± 1.53.22 ± 1.710.44
After4.17 ± 1.533.47 ± 1.540.05
SatisfactionBefore3.47 ± 1.543.64 ± 1.140.07
After4.82 ± 0.963.68 ± 0.940.01
DyspareuniaBefore3.24 ± 2.023.57 ± 2.860.39
After3.9 ± 2.243.71 ± 2.150.06
Total scoreBefore21.93 ± 4.8521.7 ± 4.780.76
After24.1 ± 4.5121.74 ± 5.050.05

*Mean ± SD; †independent t-test.

4. Comparison of marital satisfaction scores between the groups

Table 4 shows that marital satisfaction scores were significantly higher in the intervention group compared with the control group (p < 0.05). Also, no significant differences in marital satisfaction were observed in the control group both before and after the intervention (p > 0.05).

Table 4 . Comparison of marital satisfaction before and after treatment in intervention and control groups

Variable†Groupp-value*
Acupressure group (N = 58)Control group (N = 57)
Marital satisfactionBefore139.75 ± 12.53143.43 ± 13.780.13
After142.23 ± 9.07143.96 ± 13.850.45

*Mean ± SD; †t-test.

5. Comparison of sexual satisfaction scores between the groups

The independent t-test results (Table 5) show that sexual satisfaction scores were significantly higher in the intervention group compared with the control group (p = 0.18). Furthermore, the paired t-test results showed no significant difference in the sexual satisfaction scores before and after intervention in the control group (p = 0.10). Conversely, sexual satisfaction scores increased significantly in the intervention group post-treatment (p < 0.001).

Table 5 . Comparison of sexual satisfaction before and after treatment in intervention and control groups

Variable†Groupp-value*
Acupressure group (N = 58)Control group (N = 57)
Sexual satisfactionBefore70.49 ± 10.4769.01 ± 2.910.18
After77.93 ± 9.4271.48 ± 12.51< 0.001

*Mean ± SD; †t-test.

DISCUSSION

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Sexual dysfunction in women is a multifactorial condition that can be influenced by a combination of social, psychological, hormonal, environmental, and biological factors in a cyclical manner [27-29]. This condition is prevalent, affecting between 31% and 51% of Iranian women [30,31]. However, in many Eastern cultures, sexual concerns are considered taboo and are very rarely discussed [32,33]. Additionally, Iranian cultural norms and societal limitations often prevent couples from seeking expert advice or counseling, and sexual issues are seldom raised between them. This reluctance can sometimes be the source of severe family disputes and, in extreme cases, can lead to divorce [34]. Many individuals seek information and assistance regarding their sexual concerns and some hope that their healthcare providers will address these personal issues [35,36]. However, most physicians do not actively discuss sexual concerns with their patients, highlighting the need for greater attention to this issue [37,38].

In our study, participants in the control group showed some improvement in depressive symptoms, sexual function, and satisfaction following an 8-week regimen of SSRIs, though these changes were not statistically significant compared to their baseline state. Previous studies suggest that sexual function may improve in parallel with the alleviation of depressive symptoms during treatment with antidepressants. However, SSRIs are known to impair sexual function and are associated with sexual dysfunction in approximately 80% of patients with depression [27-30]. Thus, a better response to antidepressants may predict improved sexual performance, while a poor or absent response may result in unchanged or worsening sexual function.

Other research shows that while sexual function is initially more severely affected in women than in men, it often improves with antidepressant treatment [31,32]. Studies also find an overall positive effect of SSRIs on sexual function [33,39], although this issue warrants further investigation. However, despite their therapeutic benefits in terms of treatment outcomes, SSRIs are associated with several side effects including sexual dysfunction. Sexual satisfaction plays a crucial role in an individual’s physical and mental health, contributing to stronger and more durable marital relationships. Therefore, this study aimed to evaluate the potential benefits of acupressure in alleviating symptoms of sexual dysfunction as a side effect of antidepressant medication. Due to the lack of similar studies, our results were compared against research-related interventions such as acupuncture or auriculotherapy.

Our data show that acupressure significantly improved overall scores for desire, orgasm intensity, sexual satisfaction, and marital satisfaction in the intervention group. These results are consistent with those of Khamba et al. [14], who investigated the benefits of acupuncture in treating sexual dysfunction secondary to SSRI and SNRI (serotonin-epinephrine reuptake inhibitors) treatment. Their study showed significant improvements in all areas of sexual function, anxiety, and depressive symptoms among male participants. Female participants reported significant improvements in libido and lubrication, with non-significant improvements in other areas of sexual function. The authors suggested a possible role for acupuncture in the treatment of sexual side effects of SSRIs and SNRIs and highlighted the potential benefits of integrating complementary and alternative medicine practices [14].

Running et al. [13] also conducted a pilot study evaluating the immediate and long-term effects of acupuncture on symptoms of sexual dysfunction in women. Overall, while the participants reported that acupuncture improved sexual desire and reduced psychological symptoms, particularly anxiety, the improvements observed in general quality of life and overall sexual function were not statistically significant [13]. These findings suggest that acupressure may improve sexual function by reducing depression and anxiety and improving mental health. However, further research is needed to elucidate the precise mechanisms underlying these effects.

Acupressure and acupuncture work by stimulating sensory nerve fibers through the activation of skeletal muscle receptors. These signals are transmitted to the spinal cord via spinal reflexes, which can modulate sympathetic output to target organs within the same nerve region. These therapies affect the hypothalamic-pituitary-ovarian axis and increase central β-endorphin [40]. Furthermore, acupressure may enhance the regulation of cortisol secretion, ultimately reducing anxiety by increasing the production of serotonin and endorphins [41]. Therefore, by improving endocrine function, acupressure can help regulate hormones and reduce mental disorders.

In line with our findings, Saffari et al. [42] showed that auriculotherapy reduced stress and improved fertility treatment, while Wang et al.’s [43] study showed an improvement in sexual function at three, six, and nine months after treatment in the intervention group compared to the control group. Zeidabadinejad et al. [44] reported that reflexology significantly affected men’s sexual desire, while changes in women’s sexual desire were not significant, possibly due to the small sample size (five subjects in each group).

One limitation of our study was the short follow-up period. Additionally, as the questionnaires were self-reported, response bias may have influenced the results. The study also focused only on women of reproductive age (18-45 years) due to the known influence of age on sexual function [45,46], making it impossible to extrapolate the findings to all women taking antidepressants. Furthermore, the P1 and P2 placebo points were selected based on their easy accessibility, lack of placement along the meridian canal, and the minimal accumulation of acupressure points around them as confirmed by a TCM professor. However, it may have been more appropriate to use placebo points closer to the main acupoints, which should be considered in future studies. Although acupuncture carries risks such as pain and injury at the puncture site, damage to internal organs, and an increased risk of infectious diseases (e.g., hepatitis and AIDS) acupressure is non-invasive and carries no significant complications even when performed incorrectly. Furthermore, acupressure is an easy-to-use treatment method that can also be self-administered [19]. For future research, we recommend comparing acupressure and acupuncture in this demographic with longer intervention durations, while also assessing patient satisfaction.

A major strength of this study was the large sample size, which enhanced statistical power. Furthermore, we used a specific questionnaire to evaluate sexual function and applied pressure to placebo points to account for the placebo effect in the control group.

CONCLUSIONS

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In conclusion, the results of this study suggest that acupressure may be able to improve sexual function in women taking SSRIs. However, further studies are necessary to confirm these findings and to explore the underlying mechanisms.

ACKNOWLEDGEMENTS

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Not applicable.

FUNDING

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This study was funded by a grant from Yasuj University of Medical Sciences.

AUTHORS' CONTRIBUTIONS

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Conceptualization: Fatemeh Bazarganipour, Seyed-Abdolvahab Taghavi. Data curation: Nazir Hashemi Mohammad-Abad, Sahar Zafari, Fatemeh Zafari, Elahe Karimi, Arezoo Hosseini. Formal analysis: Fatemeh Bazarganipour. Funding acquisition: Nazir Hashemi Mohammad-Abad. Investigation: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Methodology: Fatemeh Bazarganipour, Seyed-Abdolvahab Taghavi. Project administration: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Resources: Nazir Hashemi Mohammad-Abad. Software: Fatemeh Bazarganipour. Supervision: Fatemeh Bazarganipour. Validation: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Visualization: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Writing - original draft: Fatemeh Bazarganipour, Seyed-Abdolvahab Taghavi. Writing - review & editing: Fatemeh Bazarganipour, Nazir Hashemi Mohammad-Abad, Seyed-Abdolvahab Taghavi, Marcello Iriti.

DATA AVAILABILITY

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The datasets generated and/or analyzed during the current study are not publicly available due to personal data protection legislation but are available from the corresponding author on reasonable request.

CONFLICT OF INTEREST

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The authors declare no conflict of interest.

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Article

Research Article

J Acupunct Meridian Stud 2024; 17(6): 196-205

Published online December 31, 2024 https://doi.org/10.51507/j.jams.2024.17.6.196

Copyright © Medical Association of Pharmacopuncture Institute.

Acupressure as an Effective Method for Improving Sexual Function in Depressant Women Treated with Selective Serotonin Reuptake Inhibitor: a Randomized Clinical Trial

Nazir Hashemi Mohammad-Abad1 , Sahar Zafari2 , Seyed-Abdolvahab Taghavi2,* , Fatemeh Zafari2 , Elahe Karimi2 , Arezoo Hosseini2 , Fatemeh Rezaei2 , Marcello Iriti3 , Fatemeh Bazarganipour4,*

1Department of Psychiatry, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
2Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
3Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
4Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran

Correspondence to:Seyed-Abdolvahab Taghavi
Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
E-mail vahab.taghavi@gmail.com

Fatemeh Bazarganipour
Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
E-mail f.bazarganipour@gmail.com

Received: March 11, 2024; Revised: March 31, 2024; Accepted: November 26, 2024

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Importance: Sexual dysfunction in individuals suffering from depression may be both a symptom of the disorder and a side effect of antidepressants. To date, and to our knowledge, no randomized controlled trials have demonstrated the effectiveness of acupressure on sexual function in women of reproductive age who take antidepressants.
Objective: This study aims to evaluate the effect of acupressure on sexual function in women of reproductive age taking Selective Serotonin Reuptake inhibitors (SSRIs).
Methods: A randomized clinical trial with a control group. In total, 115 women taking antidepressants and suffering from sexual dysfunction were recruited from Shahid Rajaee Hospital in Yasuj, Iran. They were enrolled based on the inclusion criteria and were randomly assigned to either the acupressure (intervention) or control group. Pressure was applied to subjects in the intervention group at the PC6 and SP6 acupoints, and at placebo points P1 and P2 in the control group. Treatments were administered in a sitting position, twice weekly, for two months. Sexual function was assessed using the Female Sexual Function Index at baseline and after the eight-week intervention period.
Results: The acupressure group showed significant improvements in desire, orgasm intensity, satisfaction, and total sexual function score compared with the control group (p< 0.05).
Conclusions and Relevance: This study provides important evidence for supporting the use of acupressure at these specific points to improve sexual function in women taking SSRIs. Acupressure may be a practical and effective intervention for mitigating antidepressant-induced sexual function.

Keywords: Acupressure, Female sexual function, Selective serotonin reuptake inhibitors

INTRODUCTION

Depression is the fourth most prevalent disorder in the world and accounts for the largest share of non-fatal disorders [1]. Individuals with depression often experience persistent feelings of numbness, hopelessness, helplessness, worthlessness, and guilt, leading to a loss of interest in life, work, and other previously enjoyable activities, including sex [2].

The most common treatments for depression are antidepressants known as selective serotonin reuptake inhibitors (SSRIs). However, while effective, SSRIs have been associated with side effects including nausea, sweating, tremors, dry mouth, insomnia, constipation, diarrhea, loss of appetite, and sexual dysfunction [3]. The incidence of sexual dysfunction in SSRI users ranges between 50% and 90% and includes symptoms such as erectile dysfunction, reduced libido, delayed orgasm, and pain during intercourse [4].

Sexual dysfunction in individuals with depression can be viewed both as a manifestation of the depression itself and as an adverse effect of antidepressant treatments [5,6]. When patients experience side effects, they often discontinue treatment, meaning that their symptoms continue [7]. Pharmacological treatments to eliminate these side effects include sildenafil, bupropion, tadalafil, and yohimbine. However, they can cause additional undesirable side effects such as hypotension [8,9].

Given the rising interest in complementary and alternative medicines in various fields of medical science, one promising approach is acupressure, a technique rooted in traditional Chinese medicine, with a 3000-year history [10,11].

Acupressure is widely used to treat and relieve various diseases and is based on acupuncture. However, instead of using needles, pressure is exerted on specific points on the body, which is believed to stimulate the flow of vital energy (qi), circulating throughout the body via channels called meridians. Disruption of the energy balance in the meridians leads to disease, and applying acupressure to specific areas improves the flow of qi, restoring the balance and ultimately curing the disease. Studies have shown that acupressure restores vital energy to blocked systems, and the World Health Organization has confirmed its therapeutic efficacy, particularly in activating neuroendocrine and immune mediators that play a significant role in sexual function [12,13].

Given the high prevalence of depression and its negative impact on sexual function, combined with the lack of studies conducted on the treatment of sexual disorders caused by antidepressants, this study aims to explore whether acupressure can improve sexual function in women of reproductive age taking SSRIs.

METHODS

1. Design and data collection

This study was a double-blind randomized clinical trial undertaken at Shahid Rajaee Hospital, Yasuj University of Medical Sciences, Yasuj, Iran in 2021. Both the participants and the analysts were unaware of the group assignments. The study was approved by the Ethics Committee of Yasuj University (Ref. no. IR.YUMS.REC.1399.159), and written informed consent was obtained from all participants. The trial was prospectively registered with the Iranian Registry of Clinical Trials (www.irct.ir), under registration number IRCT20160524028038N10.

Randomization was performed using a simple randomization method, with the allocation sequence generated by the Computer Random Generation program. Participants were assigned to either the intervention or control group using coded, non-transparent sealed envelopes.

The sample size was determined using Khamba et al.’s [14] method requiring a minimum of 60 participants per group. The following formula was used:

N=Z1−α2+Z1−β2S12+S22Δ2
1−α=%95    β=%80Z is the value from the table of probabilities of the standard normal distribution for the desired confidence level (e.g., Z = 1.96 for 95% confidence)S1=76.45      S2=113.45      Δ=(185.59−136.18)

2. Recruitment of participants

Inclusion criteria were as follows: women aged 18 to 45 years, able to read and write, with a Hamilton Depression Rating Scale (HDRS) score of less than 18, and a diagnosis of mild to moderate depression. Participants were required to have been on at least four weeks of antidepressant treatment that was affecting sexual function, be married in accordance with Iranian law (which prohibits sex outside of marriage), and have a sexual partner present at least 50% of each month. Additionally, participants had to be two hours postprandial. Exclusion criteria included the presence of infectious or skin diseases, acute rheumatoid arthritis, wounds or skin infections at the acupressure site, speech or hearing problems, alcohol addiction or consumption, pre-existing sexual dysfunction, bereavement (loss of a close friend or relative) in the past six months, and chronic conditions such as cardiovascular, thyroid and kidney disorders, arthritis, diabetes, and epilepsy.

3. Description of intervention

The acupressure intervention was conducted by the main researcher (F.Z) who holds an acupressure certification. The investigator received training in acupressure techniques from a Traditional Chinese Medicine (TCM) professor over five instructional sessions conducted across one month. After obtaining written consent from the eligible participants, the subjects were evaluated over a two-month period.

At baseline (time 0, before the intervention), the following parameters were assessed: sexual function using the female sexual function index (FSFI), marital satisfaction via the Enriched Marital Satisfaction Scale, severity of depressive symptoms using the HDRS, and sexual satisfaction with the Larson Sexual Satisfaction Questionnaire. After completing the questionnaires, the subjects were randomized into either the intervention (acupressure) group or the control group.

In the intervention group, pressure was applied to the PC6 and SP6 acupoints, while in the control group, placebo points (P1 and P2) were used. The PC6 and SP6 acupuncture points were chosen based on previous reference publications as part of the female sexual dysfunction protocol and are known for their potential to alleviate depressive disorders [14,15].

For the intervention, participants were instructed to lie down on a bed, fully relaxed, to receive acupressure. The PC6 acupoint is located 2 cm above the transverse fold of the wrist, along the path of the median nerve, between the long tendons of the palm and the flexor of the elbow (Fig. 1A). The SP6 acupoint is located four finger-widths above the inner ankle, behind the posterior edge of the tibia (Fig. 1B). The P1 placebo point is located between the third and the fourth toes, outside the meridian line (Fig. 1C) [16], while the P2 placebo point is located at the junction between the second and third fingers of the hand, and is also outside the meridian line (Fig. 1D).

Figure 1. Location of points. (A) P6 acupoint, (B) SP6 acupoint, (C) P1 placebo point, and (D) P2 placebo point.

In both groups, each acupoint was pressed for 10 minutes, resulting in a total of 20 minutes of pressure application. Pressure was applied in a harmonized manner, one minute clockwise and one minute counterclockwise, followed by a two-minute rest period during which the researcher massaged the acupoint to maintain meridian stimulation. Pressure continued until the participant reported mild discomfort, whereupon pressure application was stopped.

The investigator also demonstrated the appropriate amount of pressure to be applied based on the amount of nail color change at the pressure points [17-19]. Additionally, the researcher instructed the participants on the self-administration of pressure.

Both the intervention and control groups received one acupressure session performed by the researcher, with subsequent training for the participant. The participants were then instructed to conduct three additional sessions in the clinic under the researcher’s supervision. Following this, participants were trained to perform acupressure at home, with a total of twelve sessions performed twice a week with either acupressure or placebo pressure points. The intervention group was also provided with information on acupressure points and how to apply pressure.

It should be noted that participants were positioned supine in the clinic to minimize hypotension and dizziness. At home, the procedures were performed in the sitting position, to minimize hypotension and to ensure comfort during self-administration [18,19]. Pamphlets and videos explaining the placebo pressure points and application techniques were provided to the control group. The researcher also reminded participants about their intervention schedule and follow-up appointments by phone and text message. The duration of the intervention for both groups was two months.

4. Outcome measures

Demographic data, comprising age, education, occupation, weight, height, and reproductive history were collected from all participants.

Sexual function was defined as any impairment of sexual desire and arousal, dyspareunia, and/or orgasmic dysfunction. The FSFI questionnaire, developed by Rosen et al. [20], was used to evaluate sexual function over a four-week period. This 19-item questionnaire assesses six independent dimensions of female sexual function: sexual desire (4 items), arousal (4 items), lubrication (4 items), orgasm (3 items), satisfaction (3 items), and pain (3 items). The answers are rated from 0 to 5, with higher scores indicating better sexual function [20]. The FSFI has been validated for use in Iran [21].

Marital satisfaction was assessed using the Enrich Marital Satisfaction Scale, which contains 47 questions scored on a 5-point Likert scale (1-5). For the first time in Iran, Soleymanian et al. [22] designed a 47-item form of this questionnaire. A higher score indicates greater marital satisfaction. The questionnaire has also been validated in Iran [22].

Sexual satisfaction was assessed by the Larson questionnaire, which consists of 25 questions. Responses range from never (1) to always (5), with higher scores indicating greater sexual satisfaction. The Larson questionnaire has also been validated in Iran [23,24].

In this study, the severity of depressive disorder was assessed using the 21-item Persian version of the HDRS, which includes various psychometric indices. This scale evaluates a range of depression-related symptoms such as low mood, suicidality, irritability, tension, loss of appetite, lack of interest, and somatic symptoms. Responses are recorded using 3-, 4-, and 5-point Likert scales. For example, for the item “insomnia early,” the scoring was as follows: 0 = no trouble sleeping; 1 = occasional sleep difficulties (i.e., taking longer than 30 minutes to fall asleep); and 2 = frequent sleep difficulties every night. Higher scores indicate more severe depressive symptoms [25]. The reliability and validity of this scale have been confirmed in Iran [26].

The research variables were measured at baseline (week 0) and after the intervention (week 8).

5. Data analysis

Patient data were entered into SPSS version 21 statistical software. Descriptive statistics (mean, standard deviation, frequency distribution) and inferential statistics (independent t-tests and paired t-tests) were used for normally distributed variables. Non-parametric tests (e.g., the Mann-Whitney U test) were used for non-normally distributed variables. Our analysis adhered to an intention-to-treat approach, incorporating all participants in the groups to which they were randomly allocated. A p-value of ≤ 0.05 denoted statistical significance.

RESULTS

1. Sample characteristics

A total of 145 participants were initially enrolled, with 130 randomly assigned to two groups (65 in each group). Of these, 115 participants completed the follow-up (58 and 57 participants in the intervention and control groups, respectively). Participant allocation is shown in Fig. 2.

Figure 2. Flow diagram of patient’s enrolment and study progress.

Fig. 2 also shows that four participants in the intervention group and six participants in the control group discontinued the intervention due to concerns about potential adverse effects or because they believed that the treatment was ineffective. Therefore, outcomes for these participants were not included in the analysis. There were no significant differences in socio-demographic characteristics (Table 1), sexual function, marital satisfaction, or sexual satisfaction scores between the two groups prior to the intervention (p > 0.05). Therefore, attrition bias is unlikely to have affected the exposure or outcome. Because the findings related to the outcome in these individuals are not available, only data from the 58 participants in the intervention group and the 57 participants in the control group were analyzed as there was no crossover.

*Mean ± SD = t-test; †N (%) = X2..

&md=tbl&idx=1' data-target="#file-modal"">Table 1

Demographic characteristics.

VariableGroupsp-value
Intervention group (n = 58)Control group (n = 57)
Female age (years)*37.41 ± 5.7737.7 ± 6.240.79
Husband age (years)*42.63 ± 7.9844.1 ± 8.730.32
Weight (kg)*79.25 ± 11.0877.01 ± 10.060.25
Height (cm)*162.98 ± 4.52162.38 ± 5.190.5
Gravid*2.66 ± 1.982.61 ± 1.980.89
Parity*2.15 ± 1.642.15 ± 1.680.95
Occupation†0.48
Employee9 (15)13 (21.7)
Housewife51 (85)47 (78.3)
Education*10.61 ± 4.4910.7 ± 4.230.91

*Mean ± SD = t-test; †N (%) = X2..

2. Comparison of depressive disorder severity scores between the groups

The results shown in Table 2 indicate a significant improvement in the severity of depressive symptoms in the intervention group compared with the control group (p = 0.05). Additionally, the paired t-test results revealed significant differences in depressive disorder severity before and after the intervention in both the intervention (p = 0.05) and control groups (p = 0.05).

*Mean ± SD; †independent t-test; ‡paired t-test..

&md=tbl&idx=2' data-target="#file-modal"">Table 2

Comparison of sum score of depressive disorder between group.

Variable*GroupTime
BeforeAfterp-value‡
Hamilton Depression Rating Scale scoreIntervention group (n = 58)20.59 ± 3.1712.91 ± 5.900.05
Control group (n = 57)19.81 ± 5.7516.52 ± 9.450.05
p-value†0.690.05

*Mean ± SD; †independent t-test; ‡paired t-test..

3. Comparison of sexual function scores between the groups

Table 3 shows that sexual desire, orgasm intensity, satisfaction, and total sexual function scores were significantly higher in the intervention group compared with the control group (p < 0.05).

*Mean ± SD; †independent t-test..

&md=tbl&idx=3' data-target="#file-modal"">Table 3

Comparison of dimensions of sexual function before and after intervention in the study groups.

Variable*Groupp-value†
Intervention group (n = 58)Control group (n = 57)
DesireBefore4.32 ± 1.014.41 ± 1.060.2
After5.07 ± 0.814.66 ± 0.840.05
ExcitementBefore2.77 ± 1.452.33 ± 1.40.68
After3.10 ± 1.032.8 ± 1.10.14
LubricationBefore3.33 ± 1.653.02 ± 1.690.99
After3.46 ± 1.623.07 ± 1.650.06
OrgasmBefore3.99 ± 1.53.22 ± 1.710.44
After4.17 ± 1.533.47 ± 1.540.05
SatisfactionBefore3.47 ± 1.543.64 ± 1.140.07
After4.82 ± 0.963.68 ± 0.940.01
DyspareuniaBefore3.24 ± 2.023.57 ± 2.860.39
After3.9 ± 2.243.71 ± 2.150.06
Total scoreBefore21.93 ± 4.8521.7 ± 4.780.76
After24.1 ± 4.5121.74 ± 5.050.05

*Mean ± SD; †independent t-test..

4. Comparison of marital satisfaction scores between the groups

Table 4 shows that marital satisfaction scores were significantly higher in the intervention group compared with the control group (p < 0.05). Also, no significant differences in marital satisfaction were observed in the control group both before and after the intervention (p > 0.05).

*Mean ± SD; †t-test..

&md=tbl&idx=4' data-target="#file-modal"">Table 4

Comparison of marital satisfaction before and after treatment in intervention and control groups.

Variable†Groupp-value*
Acupressure group (N = 58)Control group (N = 57)
Marital satisfactionBefore139.75 ± 12.53143.43 ± 13.780.13
After142.23 ± 9.07143.96 ± 13.850.45

*Mean ± SD; †t-test..

5. Comparison of sexual satisfaction scores between the groups

The independent t-test results (Table 5) show that sexual satisfaction scores were significantly higher in the intervention group compared with the control group (p = 0.18). Furthermore, the paired t-test results showed no significant difference in the sexual satisfaction scores before and after intervention in the control group (p = 0.10). Conversely, sexual satisfaction scores increased significantly in the intervention group post-treatment (p < 0.001).

*Mean ± SD; †t-test..

&md=tbl&idx=5' data-target="#file-modal"">Table 5

Comparison of sexual satisfaction before and after treatment in intervention and control groups.

Variable†Groupp-value*
Acupressure group (N = 58)Control group (N = 57)
Sexual satisfactionBefore70.49 ± 10.4769.01 ± 2.910.18
After77.93 ± 9.4271.48 ± 12.51< 0.001

*Mean ± SD; †t-test..

DISCUSSION

Sexual dysfunction in women is a multifactorial condition that can be influenced by a combination of social, psychological, hormonal, environmental, and biological factors in a cyclical manner [27-29]. This condition is prevalent, affecting between 31% and 51% of Iranian women [30,31]. However, in many Eastern cultures, sexual concerns are considered taboo and are very rarely discussed [32,33]. Additionally, Iranian cultural norms and societal limitations often prevent couples from seeking expert advice or counseling, and sexual issues are seldom raised between them. This reluctance can sometimes be the source of severe family disputes and, in extreme cases, can lead to divorce [34]. Many individuals seek information and assistance regarding their sexual concerns and some hope that their healthcare providers will address these personal issues [35,36]. However, most physicians do not actively discuss sexual concerns with their patients, highlighting the need for greater attention to this issue [37,38].

In our study, participants in the control group showed some improvement in depressive symptoms, sexual function, and satisfaction following an 8-week regimen of SSRIs, though these changes were not statistically significant compared to their baseline state. Previous studies suggest that sexual function may improve in parallel with the alleviation of depressive symptoms during treatment with antidepressants. However, SSRIs are known to impair sexual function and are associated with sexual dysfunction in approximately 80% of patients with depression [27-30]. Thus, a better response to antidepressants may predict improved sexual performance, while a poor or absent response may result in unchanged or worsening sexual function.

Other research shows that while sexual function is initially more severely affected in women than in men, it often improves with antidepressant treatment [31,32]. Studies also find an overall positive effect of SSRIs on sexual function [33,39], although this issue warrants further investigation. However, despite their therapeutic benefits in terms of treatment outcomes, SSRIs are associated with several side effects including sexual dysfunction. Sexual satisfaction plays a crucial role in an individual’s physical and mental health, contributing to stronger and more durable marital relationships. Therefore, this study aimed to evaluate the potential benefits of acupressure in alleviating symptoms of sexual dysfunction as a side effect of antidepressant medication. Due to the lack of similar studies, our results were compared against research-related interventions such as acupuncture or auriculotherapy.

Our data show that acupressure significantly improved overall scores for desire, orgasm intensity, sexual satisfaction, and marital satisfaction in the intervention group. These results are consistent with those of Khamba et al. [14], who investigated the benefits of acupuncture in treating sexual dysfunction secondary to SSRI and SNRI (serotonin-epinephrine reuptake inhibitors) treatment. Their study showed significant improvements in all areas of sexual function, anxiety, and depressive symptoms among male participants. Female participants reported significant improvements in libido and lubrication, with non-significant improvements in other areas of sexual function. The authors suggested a possible role for acupuncture in the treatment of sexual side effects of SSRIs and SNRIs and highlighted the potential benefits of integrating complementary and alternative medicine practices [14].

Running et al. [13] also conducted a pilot study evaluating the immediate and long-term effects of acupuncture on symptoms of sexual dysfunction in women. Overall, while the participants reported that acupuncture improved sexual desire and reduced psychological symptoms, particularly anxiety, the improvements observed in general quality of life and overall sexual function were not statistically significant [13]. These findings suggest that acupressure may improve sexual function by reducing depression and anxiety and improving mental health. However, further research is needed to elucidate the precise mechanisms underlying these effects.

Acupressure and acupuncture work by stimulating sensory nerve fibers through the activation of skeletal muscle receptors. These signals are transmitted to the spinal cord via spinal reflexes, which can modulate sympathetic output to target organs within the same nerve region. These therapies affect the hypothalamic-pituitary-ovarian axis and increase central β-endorphin [40]. Furthermore, acupressure may enhance the regulation of cortisol secretion, ultimately reducing anxiety by increasing the production of serotonin and endorphins [41]. Therefore, by improving endocrine function, acupressure can help regulate hormones and reduce mental disorders.

In line with our findings, Saffari et al. [42] showed that auriculotherapy reduced stress and improved fertility treatment, while Wang et al.’s [43] study showed an improvement in sexual function at three, six, and nine months after treatment in the intervention group compared to the control group. Zeidabadinejad et al. [44] reported that reflexology significantly affected men’s sexual desire, while changes in women’s sexual desire were not significant, possibly due to the small sample size (five subjects in each group).

One limitation of our study was the short follow-up period. Additionally, as the questionnaires were self-reported, response bias may have influenced the results. The study also focused only on women of reproductive age (18-45 years) due to the known influence of age on sexual function [45,46], making it impossible to extrapolate the findings to all women taking antidepressants. Furthermore, the P1 and P2 placebo points were selected based on their easy accessibility, lack of placement along the meridian canal, and the minimal accumulation of acupressure points around them as confirmed by a TCM professor. However, it may have been more appropriate to use placebo points closer to the main acupoints, which should be considered in future studies. Although acupuncture carries risks such as pain and injury at the puncture site, damage to internal organs, and an increased risk of infectious diseases (e.g., hepatitis and AIDS) acupressure is non-invasive and carries no significant complications even when performed incorrectly. Furthermore, acupressure is an easy-to-use treatment method that can also be self-administered [19]. For future research, we recommend comparing acupressure and acupuncture in this demographic with longer intervention durations, while also assessing patient satisfaction.

A major strength of this study was the large sample size, which enhanced statistical power. Furthermore, we used a specific questionnaire to evaluate sexual function and applied pressure to placebo points to account for the placebo effect in the control group.

CONCLUSIONS

In conclusion, the results of this study suggest that acupressure may be able to improve sexual function in women taking SSRIs. However, further studies are necessary to confirm these findings and to explore the underlying mechanisms.

ACKNOWLEDGEMENTS

Not applicable.

FUNDING

This study was funded by a grant from Yasuj University of Medical Sciences.

AUTHORS' CONTRIBUTIONS

Conceptualization: Fatemeh Bazarganipour, Seyed-Abdolvahab Taghavi. Data curation: Nazir Hashemi Mohammad-Abad, Sahar Zafari, Fatemeh Zafari, Elahe Karimi, Arezoo Hosseini. Formal analysis: Fatemeh Bazarganipour. Funding acquisition: Nazir Hashemi Mohammad-Abad. Investigation: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Methodology: Fatemeh Bazarganipour, Seyed-Abdolvahab Taghavi. Project administration: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Resources: Nazir Hashemi Mohammad-Abad. Software: Fatemeh Bazarganipour. Supervision: Fatemeh Bazarganipour. Validation: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Visualization: Nazir Hashemi Mohammad-Abad, Fatemeh Bazarganipour. Writing - original draft: Fatemeh Bazarganipour, Seyed-Abdolvahab Taghavi. Writing - review & editing: Fatemeh Bazarganipour, Nazir Hashemi Mohammad-Abad, Seyed-Abdolvahab Taghavi, Marcello Iriti.

DATA AVAILABILITY

The datasets generated and/or analyzed during the current study are not publicly available due to personal data protection legislation but are available from the corresponding author on reasonable request.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Fig 1.

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Figure 1.Location of points. (A) P6 acupoint, (B) SP6 acupoint, (C) P1 placebo point, and (D) P2 placebo point.
Journal of Acupuncture and Meridian Studies 2024; 17: 196-205https://doi.org/10.51507/j.jams.2024.17.6.196

Fig 2.

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Figure 2.Flow diagram of patient’s enrolment and study progress.
Journal of Acupuncture and Meridian Studies 2024; 17: 196-205https://doi.org/10.51507/j.jams.2024.17.6.196

Table 1 . Demographic characteristics.

VariableGroupsp-value
Intervention group (n = 58)Control group (n = 57)
Female age (years)*37.41 ± 5.7737.7 ± 6.240.79
Husband age (years)*42.63 ± 7.9844.1 ± 8.730.32
Weight (kg)*79.25 ± 11.0877.01 ± 10.060.25
Height (cm)*162.98 ± 4.52162.38 ± 5.190.5
Gravid*2.66 ± 1.982.61 ± 1.980.89
Parity*2.15 ± 1.642.15 ± 1.680.95
Occupation†0.48
Employee9 (15)13 (21.7)
Housewife51 (85)47 (78.3)
Education*10.61 ± 4.4910.7 ± 4.230.91

*Mean ± SD = t-test; †N (%) = X2..

Table 2 . Comparison of sum score of depressive disorder between group.

Variable*GroupTime
BeforeAfterp-value‡
Hamilton Depression Rating Scale scoreIntervention group (n = 58)20.59 ± 3.1712.91 ± 5.900.05
Control group (n = 57)19.81 ± 5.7516.52 ± 9.450.05
p-value†0.690.05

*Mean ± SD; †independent t-test; ‡paired t-test..

Table 3 . Comparison of dimensions of sexual function before and after intervention in the study groups.

Variable*Groupp-value†
Intervention group (n = 58)Control group (n = 57)
DesireBefore4.32 ± 1.014.41 ± 1.060.2
After5.07 ± 0.814.66 ± 0.840.05
ExcitementBefore2.77 ± 1.452.33 ± 1.40.68
After3.10 ± 1.032.8 ± 1.10.14
LubricationBefore3.33 ± 1.653.02 ± 1.690.99
After3.46 ± 1.623.07 ± 1.650.06
OrgasmBefore3.99 ± 1.53.22 ± 1.710.44
After4.17 ± 1.533.47 ± 1.540.05
SatisfactionBefore3.47 ± 1.543.64 ± 1.140.07
After4.82 ± 0.963.68 ± 0.940.01
DyspareuniaBefore3.24 ± 2.023.57 ± 2.860.39
After3.9 ± 2.243.71 ± 2.150.06
Total scoreBefore21.93 ± 4.8521.7 ± 4.780.76
After24.1 ± 4.5121.74 ± 5.050.05

*Mean ± SD; †independent t-test..

Table 4 . Comparison of marital satisfaction before and after treatment in intervention and control groups.

Variable†Groupp-value*
Acupressure group (N = 58)Control group (N = 57)
Marital satisfactionBefore139.75 ± 12.53143.43 ± 13.780.13
After142.23 ± 9.07143.96 ± 13.850.45

*Mean ± SD; †t-test..

Table 5 . Comparison of sexual satisfaction before and after treatment in intervention and control groups.

Variable†Groupp-value*
Acupressure group (N = 58)Control group (N = 57)
Sexual satisfactionBefore70.49 ± 10.4769.01 ± 2.910.18
After77.93 ± 9.4271.48 ± 12.51< 0.001

*Mean ± SD; †t-test..

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