sexual dysfunctions ( sds ) frequently affect the elderly and can lead to dissatisfaction with interpersonal relationships and have an adverse impact on overall well - being and mood .
sds include erectile dysfunction , orgasmic dysfunction , lack of sexual desire , dissatisfaction with intercourse , etc . .
among these , the majority of patients of both sexes report a lack of sexual desire , and men , especially , report erectile dysfunction .
epidemiological data have shown that about 40%  45% of elderly women and 20%  30% of elderly men may have sds . furthermore
the prevalence of sds in men younger than 40 years of age has been reported to be 2% whereas that in men over 80 years of age has been reported to be 86% .
therefore , many patients with sds tend to seek current medical intervention for management of their sds , especially erectile dysfunction ( ed ) , such as medication , intraurethral suppositories or intracavernosal injeccasetions , implantation of a penile prosthesis , and hormonal therapy or psychotherapy .
pharmacopuncture as a new and unique modality of treatment in korean medicine has had a promising effect on many kinds of diseases . however , until now , the focus of experiments and case reports has been musculoskeletal diseases , and to the best of our knowledge , no studies on the use of pharmacopuncture to treat sds exist .
therefore , this study reports one case of sexual dysfunction ( sd ) treated with only sweet bee venom ( sbv ) pharmacopuncture .
a 51-year - old man complaining of sd was administered udenafil ( phosphodiesterase 5 inhibitor ) for 15 days .
he had low back pain since 2009 , and his symptom , such as numbness in both leg and feet , which had been severe , deteriorated .
he underwent a magnetic resonance imaging ( mri ) scan of the lower back , and the intervertebral disc space between l5 and s1 was found to be narrowed and a herniated disc was manifested .
thus , he decided to undergo surgery to insert artificial cartilage between l5 and s1 .
after surgery , the numbness in both legs and feet and the lower back pain were decreasing . during his admission period from october 10 to october 30 , he asked if sd could be treated with korean medicine . after receiving our response
, he decided to undergo 20 days of treatments without any kinds of herbal medicines and western drugs for sd .
he completed the international index for erectile dysfunction questionnaires ( iief , appendix )   before and after treatment .
firstly , gwanwon ( cv4 ) and hoeeum ( cv1 ) were used at doses of 0.1 cc and 0.2 cc , respectively , as well as sinsu ( bl23 ) and gihaesu ( bl24 ) at a dose of 0.1 cc at each site bilaterally .
the pharmacopuncture treatment using these 4 points was conducted for 10 days . after that procedure ,
cv4 and cv1 were selected to maintain the sexual function effect , and the sbv pharmacopuncture was administered at doses of 0.1 cc and 0.2 cc , respectively , every other day for 10 days ( fig 1 ) . to evaluate the sexual function ,
we had the patient complete the iief questionnaire before and after treatment . in this study , no medical diagnostic devices were used to measure erectile dysfunction .
sexual dysfunction involves several factors concerning mental satisfaction , so although completing and interpreting the results of a questionnaire are easy , no absolute and discrete values exist for individuals with and without sd . in a study , the iief questionnaire was tested in 111 men with sexual dysfunction and 109 age - matched normal volunteers .
therefore , mean scores for controls ( normal volunteers ) and patients could be obtained . in this study , those mean scores were adopted and the scores for this case , both pre - treatment and post - treatment , and the control s scores and the patient s scores are presented in ( fig 2 ) .
firstly , gwanwon ( cv4 ) and hoeeum ( cv1 ) were used at doses of 0.1 cc and 0.2 cc , respectively , as well as sinsu ( bl23 ) and gihaesu ( bl24 ) at a dose of 0.1 cc at each site bilaterally . the pharmacopuncture treatment using these 4 points
were selected to maintain the sexual function effect , and the sbv pharmacopuncture was administered at doses of 0.1 cc and 0.2 cc , respectively , every other day for 10 days ( fig 1 ) .
to evaluate the sexual function , we had the patient complete the iief questionnaire before and after treatment . in this study , no medical diagnostic devices were used to measure erectile dysfunction .
sexual dysfunction involves several factors concerning mental satisfaction , so although completing and interpreting the results of a questionnaire are easy , no absolute and discrete values exist for individuals with and without sd . in a study
, the iief questionnaire was tested in 111 men with sexual dysfunction and 109 age - matched normal volunteers .
therefore , mean scores for controls ( normal volunteers ) and patients could be obtained . in this study , those mean scores were adopted and the scores for this case , both pre - treatment and post - treatment , and the control s scores and the patient s scores are presented in ( fig 2 ) .
in this study , four acupuncture points were used , cv4 , cv1 , bl23 and bl24 .
cv4 is the front collecting point ( mu point ) of the small intestine and represents the intersection of the interior branches of the three yin channels of the foot .
it can explain the broad effect on gynecological syndromes and disorders of the urogenital tract . also , it can play an important role in tonifying in cases of emotional and physical exhaustion .
in traditional chinese medicine ( tcm ) , it can nourish blood and yin , warm the uterus and lower warmer , invigorate kidney , yang and original qi ( yuan qi ) , and expel dampness and cold from the lower warmer .
cv1 is the beginning point of the governing vessel , the penetrating vessel and the conception vessel .
thus , its effect lies in difficult urination and defecation , enuresis and impotence , pain in the penis , sweating of genitals , etc .
bl23 is the back shu point of the kidney , so its indication lies in strengthening the renal function and circulation , and its point is used for all chronic diseases including disorders of the urogenital tract   bl24 is one of the back shu points , and its action strengthens the lower back , regulates menstruation , and invigorates blood ; especially , it is useful for lower backache and stiffness of the lower back .
the iief questionnaire is composed of 15 questions , and it is a useful tool in a clinical setting .
it is a validated , multidimensional , self - reporting questionnaire and can be used to evaluate erectile function and treatment outcomes .
the 15 questions can be classified into 5 categories : erectile function , orgasmic function , sexual desire , intercourse satisfaction and overall satisfaction .
for example question numbers 1 , 2 , 3 , 4 , 5 and 15 can be categorized as erectile function .
the perfect score differs according to the category , being 30 for erectile function , 10 for orgasmic function , 10 for sexual desire , 15 for satisfaction with intercourse , and 10 for overall satisfaction . in this case study ,
the patient s scores in each category were similar to those of the control group , except for sexual desire , where the patient s scores were very low .
after treatment , the results showed improved erectile function , sexual desire , satisfaction with intercourse , and overall satisfaction .
based on the patient s subjective self - evaluation , he also showed improvements in the duration of erection , hardness ( vascularity ) of the penis , and shortening of recovery period ( re - action ) , his lower back pain decreased , the flow of urine when urinating was not interrupted , and generally he felt more confident in his life .
although such sign as eye contact , brightness of eyes , volume of his voice , etc .
are subjective , in this circumstance , a personal problem , observing such features may be helpful .
this study has limitations in that the result of 1 case can not be generalized because of loss of control and insufficient number of subjects . besides the iief questionnaire , no other signs of improvement , such as pulse diagnosis , digital thermal imaging test , etc .
nevertheless , this study could be regarded as helpful to broaden the scope for using sbv pharmacopuncture to treat urogenital diseases . in the future , additional systematic research or randomized clinical trials in this area
will be needed to find the ways to treat sexual problems using pharmacopuncture and korean medicine treatments .
 sexual dysfunction ( sd ) is a health problem which occurs during any phase of the sexual response cycle that keeps the individual or couple from experiencing satisfaction from the sexual activity . 
 sd covers a wide variety of symptoms like in men , erectile dysfunction and premature or delayed ejaculation , in women , spasms of the vagina and pain with sexual intercourse , in both sexes , sexual desire and response . and pharmacopuncture 
 , i.e. injection of subclinical doses of drugs , mostly herb medicine , in acupoints , has been adopted with successful results . 
 this case report showed the effect of bee venom on sd . a 51-year - old male patient with sd , who had a past history of taking western medication to treat his sd and who had previously undergone surgery on his lower back due to a herniated disc , received treatments using pharmacopuncture of sweet bee venom ( sbv ) at gwanwon ( cv4 ) , hoeeum ( cv1 ) , sinsu ( bl23 ) , and gihaesu ( bl24 ) for 20 days . 
 objectively , the patient showed improvement on most items on the international index for erectile dysfunction ( iief ) like 28 to 29 out of perfect score 30 for erectile function , 10 to 10 out of perfect score 10 for orgasmic function , 6 to 8 out of perfect score 10 for sexual desire , 10 to 13 out of perfect score 15 for satisfaction with intercourse , and 6 to 8 out of perfect score 10 for overall satisfaction ; subjectively , his words , the tone of his voice and the look of confidence in his eyes all indicated improvement . among the variety of effects of sbv pharmacopuncture , 
 urogenital problems such as sd may be health problems that pharmacopuncture can treat effectively . 
1. Introduction
2. Case Report
2.1. Treatment protocol
2.2. Evaluation
3. Discussion