Background

Male factor infertility contributes to approximately 50% of all infertility cases, with declining sperm quality observed globally over recent decades. Concurrently, sexual health issues such as low libido and erectile dysfunction (ED) affect a substantial proportion of men, with prevalence rates for ED estimated at 52% among those aged 40–70 years. These conditions share common underlying mechanisms, including hormonal imbalances (particularly low testosterone), oxidative stress, chronic inflammation, poor testicular blood flow, and psychological factors such as stress and anxiety.

Conventional treatments include medications (e.g., phosphodiesterase inhibitors for ED), hormone therapy, assisted reproductive technologies (ART), and lifestyle modifications. However, many men seek complementary approaches due to side effects, cost, or preference for non-pharmaceutical options. Traditional Chinese Medicine (TCM) offers acupressure—a needle-free technique applying manual pressure to specific body points—as a potential adjunctive therapy. Acupressure is based on the same meridian theory as acupuncture but is safer, self-administered, and suitable for home use. This review synthesizes current evidence for acupressure and acupuncture in male sexual and reproductive health, with practical guidance for clinical or personal application.

Evidence for Male Libido and Erectile Function

Direct Acupressure Research

A 2019 study by Zarghami and colleagues directly investigated acupressure therapy for male sexual performance. Men receiving acupressure demonstrated an 18.27% to 18.6% increase in overall sexual performance scores compared to controls. The researchers concluded that acupressure effectively improves male sexual function and recommended greater attention to psycho-physiological interventions in sexual health care.

Acupuncture Evidence (Informing Acupressure)

While direct acupressure studies are limited, acupuncture research provides mechanistic support:

• A 2019 systematic review and meta-analysis of 22 RCTs found that acupuncture combined with herbal medicine significantly improved erectile function compared to herbs alone. Additionally, acupuncture combined with tadalafil (a standard ED medication) showed better cure rates than medication alone. The evidence was strongest for psychogenic ED (erectile dysfunction without organic cause).

• Multiple studies have identified specific acupuncture points—CV4, SP6, LV3, and ST36—as effective for increasing testosterone levels. A 2025 review further noted that points including Shen Men (ear point), CV4, KI1, and GV20 may support sexual health by reducing stress and enhancing pelvic energy flow.

Evidence for Male Fertility and Sperm Quality

The fertility evidence is more extensive, though still characterized by mixed findings and methodological heterogeneity.

Positive Findings: Acupuncture Improves Sperm Parameters

• A 2024 systematic review and meta-analysis of 11 RCTs (1,172 men) reported that acupuncture significantly improved clinical fertility outcomes, including sperm density, progressive motility, and viability. The effect was particularly strong for standalone acupuncture (odds ratio 7.6), and the analysis validated 12 weeks as the optimal treatment duration.
• A separate analysis of 11 studies found acupuncture more effective than a common hormone treatment, with a success ratio of 1.89.
• A 2024 study on Coenzyme Q10 combined with electroacupuncture demonstrated notable improvements: sperm motility increased from 41.4% to 56.4%, and total motile sperm count rose from 33.59×10⁶ to 78.63×10⁶. This suggests that acupuncture may enhance the effects of antioxidant therapies.
• A 2022 review of 27 clinical trials found that acupuncture positively impacts testicular blood flow, hormone regulation (including gonadotropins and testosterone), and antioxidant systems—all key mechanisms for spermatogenesis.

Mixed or Null Findings: Need for Caution

• A 2021 systematic review and meta-analysis found no clear superiority for acupuncture alone in improving sperm motility, concentration, or semen volume compared to placebo. However, it did suggest that adjuvant acupuncture might enhance the effects of medications on sperm parameters. The authors noted high study heterogeneity as a limitation.

Proposed Mechanisms

Acupuncture and acupressure are believed to work through several physiological pathways:

1. Neuroendocrine regulation: Modulating hypothalamic-pituitary-gonadal (HPG) axis hormones, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone.
2. Hemodynamic effects: Increasing blood flow to the testes and pelvic organs.
3. Anti-inflammatory and antioxidant effects: Reducing oxidative stress damage to sperm DNA.
4. Stress reduction: Lowering cortisol levels, which can suppress libido and testosterone.

Practical Acupressure Protocol for Male Sexual Health

Based on TCM principles and clinical studies (citing points such as CV4, SP6, LV3, KI1, and GV20), the following routine is recommended. For optimal results, practice 2–3 times daily, applying firm but comfortable pressure with a thumb or finger for 30–60 seconds per point, using circular or steady pressure.

Point Name	Location	Primary Indication	Technique
CV4 (Conception Vessel 4)	2–3 finger-widths directly below the navel, on the midline	Strengthens “Kidney Qi,” enhances blood flow to pelvic region, supports erectile function	Gentle deep pressure with fingertip; can be combined with slow abdominal breathing
SP6 (Spleen 6)	Four finger-widths above the tip of the inner ankle bone, just behind the shin bone	Regulates reproductive hormones, addresses low libido, supports overall vitality	Press firmly; may be tender
LV3 (Liver 3)	On the top of the foot, in the depression between the first and second toes	Reduces stress, smoothes liver energy, improves erectile function	Deep pressure while exhaling
KI1 (Kidney 1)	Center of the sole of the foot, in the depression when the foot is curled	Invigorates kidney energy, grounds the body, addresses fatigue-related libido loss	Thumb pressure or gentle tapping
GV20 (Governing Vessel 20)	Top of the head, on the midline (connect a line from the tops of both ears—the midpoint is GV20)	Calms the mind, reduces stress and anxiety, clears mental blocks to libido	Light fingertip pressure or gentle tapping (not deep pressure)
Lower Back / Sacral Area	The bony plate at the base of the spine, between the hips	Stimulates pelvic splanchnic nerves, enhances local circulation to reproductive organs	Massage, tapping, or palm pressure for 1–2 minutes
CV1 (Perineum)	Midpoint between the anus and the scrotum	Traditionally used in TCM for impotence and low vitality	Very gentle pressure only; avoid in acute infections
ST36 (Stomach 36)	Four finger-widths below the kneecap, one finger-width outside the shin bone	General vitality, energy (Qi) tonic, supports hormonal balance	Firm pressure or kneading
CV6 (Conception Vessel 6)	On the midline of the lower abdomen,1.5 finger-widths (approximately 1–1.5 inches or 2.5–3.8 cm) directly below the center of the navel (umbilicus).	CV6 is the primary point for tonifying overall Qi, which is the energetic engine behind all bodily functions including sexual drive	Use a clockwise circular motion (tonifying) while pressing. Small circles (about the size of a pea) are more effective than large ones.

Important Clinical Considerations

1. Acupuncture vs. Acupressure: Most high-quality evidence comes from acupuncture (needle) studies. Acupressure is presumed to have similar but potentially milder effects due to lower stimulation intensity. Direct acupressure research is urgently needed.
2. Adjunctive, not替代: Acupressure should complement, not replace, conventional medical evaluation. Underlying conditions such as varicocele, hypogonadism, thyroid disorders, diabetes, or medication side effects must be ruled out first.
3. Treatment Duration: Evidence suggests at least 8–12 weeks of consistent practice is required to see meaningful changes in sperm parameters or hormone levels. Acute libido changes may occur sooner.
4. Lifestyle Synergy: Acupressure appears most effective when combined with:
   1. Regular aerobic exercise
   1. Antioxidant-rich diet (zinc, selenium, CoQ10, vitamin D)
   1. Stress management (sleep, mindfulness)
   1. Avoidance of smoking, excessive alcohol, and heat exposure to the testes
5. Safety: Acupressure is generally safe. Avoid points CV1 and lower back pressure if there is active infection, bleeding disorder, or testicular trauma. Pregnant women should avoid SP6 and CV4 (though this review focuses on males).

Absolute Contraindications (Do Not Perform Acupressure)

While acupressure is generally very safe when self-administered correctly, certain conditions require caution or complete avoidance. Please review the following before starting any acupressure protocol.

Condition	Reason	Action
Febrile illness (fever over 38°C / 100.4°F)	Acupressure can raise body temperature further or mask symptoms	Wait until fever resolves
Acute testicular pain, torsion, or infection (e.g., epididymitis, orchitis)	Pressure may worsen inflammation or spread infection	Seek immediate medical care
Bleeding disorders (hemophilia, thrombocytopenia) or taking anticoagulant medications (warfarin, apixaban, rivaroxaban, high-dose aspirin)	Firm pressure can cause internal bruising or hematoma	Use only very light, superficial pressure after consulting your doctor
Recent surgery in the pelvic, abdominal, or lower back area (within 6 weeks)	Pressure may disrupt healing or cause pain	Avoid affected region until cleared by surgeon
Active skin infection, rash, burn, or wound at the acupressure point site	Pressure can spread infection or delay healing	Work around the area or avoid until healed
Severe uncontrolled hypertension (blood pressure >180/110 mmHg)	Stimulation of certain points (e.g., lower back, CV4) may transiently raise blood pressure	Consult doctor first; use only gentle relaxation points (e.g., GV20)
Hernia (inguinal or abdominal)	Pressure on lower abdomen (e.g., CV4, CV6) may aggravate hernia	Avoid direct abdominal pressure

Relative Contraindications (Use with Caution or Medical Guidance)

Condition	Precaution
Diabetes with peripheral neuropathy	May not feel pain or bruising; use lighter pressure and inspect skin regularly
Chronic lower back pain or spinal conditions (e.g., herniated disc, spinal stenosis)	Avoid deep pressure on sacrum; gentle massage may be acceptable
Testicular varicocele	Avoid direct pressure on CV1 (perineum) and lower abdomen; focus on leg points (SP6, ST36) instead
History of pelvic trauma or surgery (e.g., prostatectomy, hernia repair)	Wait at least 6 weeks post-surgery; then start with very gentle pressure
Psychological conditions with dissociation or self-harm risk	Acupressure is safe but should be taught by a professional to ensure proper technique
Pregnancy (relevant if treating a male’s partner or if the patient is a transgender man who could be pregnant)	Avoid SP6, CV4, and lower back/sacrum as these can stimulate uterine contractions

General Safety Guidelines

1. Pressure intensity: Use firm but never painful pressure. A mild ache, warmth, or tingling is normal. Sharp, shooting, or numbing pain means you are pressing too hard.
2. Duration: Limit each point to 30–60 seconds. Prolonged pressure (over 2 minutes) on a single point may over-stimulate the area.
3. Frequency: 2–3 times daily is sufficient. More is not necessarily better.
4. Hydration: Drink a glass of water after acupressure to help flush metabolic byproducts.
5. When to stop: Discontinue immediately if you experience dizziness, nausea, increased pain, or unusual bruising. Consult a doctor if symptoms persist.
6. Combination with other therapies: Acupressure can safely be combined with medications, supplements (e.g., CoQ10), and lifestyle changes. However, inform your doctor about all complementary practices.

When to Seek Medical Attention Instead of Acupressure

Do not rely on acupressure if you experience any of the following—seek prompt medical evaluation:

• Sudden onset of erectile dysfunction (especially after trauma)
• Testicular lump, swelling, or severe pain
• Blood in semen (hematospermia)
• Inability to achieve any erection for more than 3 months
• Fertility concerns lasting over 12 months of unprotected intercourse (6 months if over age 35)
• Signs of low testosterone (fatigue, depression, loss of muscle mass, hot flashes)

Conclusion

Acupressure offers a low-risk, self-administered complementary approach for men seeking to improve libido and fertility. Direct evidence for acupressure itself is limited but promising (one study showing ~18% improvement in sexual performance). Indirect evidence from acupuncture research supports potential benefits for sperm quality (particularly when combined with antioxidants like CoQ10 over 12 weeks) and erectile function (especially for psychogenic ED when combined with conventional treatments). Key points such as CV4, SP6, LV3, KI1, and GV20 have been identified in clinical studies. However, given the mixed findings and methodological limitations of existing research, acupressure should be viewed as an adjunctive strategy rather than a standalone cure. Men experiencing infertility or sexual dysfunction should undergo thorough medical evaluation first.

 References

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2. Li, S., et al. (2021). Acupuncture for oligospermia and asthenozoospermia: A systematic review and meta-analysis. Medicine, 100(48), e27816.
3. Myeong, J., et al. (2020). The effectiveness and safety of acupuncture for poor semen quality in infertile males: A systematic review and meta-analysis. European Journal of Integrative Medicine.
4. Ramezani, M., Mansouri, E., Sardasht, F. G., et al. (2018). The effectiveness of acupuncture for treating erectile dysfunction: A systematic review of clinical trials. Journal of Midwifery and Reproductive Health.
5. Wang, J., et al. (2019). Acupuncture for treatment of erectile dysfunction: A systematic review and meta-analysis. The World Journal of Men’s Health, 37(3), 322–338.
6. Zarghami, M. H., Ahmadi, K., Bay, R., & Fathi-Ashtiani, A. (2019). The effect of intervention with acupressure therapy on improving overall male sexual performance. Journal of Pharmaceutical Research International, 1–8.
7. Zhou, Z., Wang, F., Li, M., et al. (2024). Acupuncture for the treatment of male infertility: A systematic review and meta-analysis. Biomedical Journal of Scientific & Technical Research, 56(3).
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