We've Been Needling the Pelvic Floor for Thousands of Years
Acupuncturists: It's Time to Take Up Space.
CV 1 (Hui Yin; Meeting of Yin) sits in the center of the perineum, between the anus and the posterior labial commissure in female bodies, between the anus and the scrotum in male bodies. GV 1 (Chang Qiang; Long Strong) sits at the tip of the coccyx. These two points are the meeting place of the Ren, Du and Chong vessels. The three extraordinary vessels that govern the pelvic bowl.
We have been needling them for over two thousand years.
So here is the question I want every acupuncturist reading this to sit with: why have we let the pelvic floor become someone else's medicine?
Pelvic physical therapy is brilliant work. The PTs in your community are colleagues, not competitors, and I want to say that plainly. But the conversation in the broader culture has quietly shifted to a place where pelvic care equals pelvic PT. Full stop. And when our profession gets left out of that conversation, it is not just bad for us. It is bad for the clients who need every tool in the toolbox and only know about one.
We have something they do not have. We have the three pillars.
The biomedical pillar is real and the research is there. A 2024 systematic review and meta analysis in Frontiers in Medicine found that acupuncture combined with pelvic floor muscle training significantly improved outcomes for women with stress urinary incontinence over PFMT alone. A 2022 single blinded RCT in Neurourology and Urodynamics (Wan et al.) showed the same. A 2023 RCT in Revista Latino-Americana de Enfermagem demonstrated that systemic acupuncture combined with pelvic floor muscle training was more effective than PFMT alone for urinary incontinence following radical prostatectomy. The evidence is no longer thin. It is accumulating, and it is good.
The TCM pillar carries thousands of years of pattern differentiation, channel theory and zang fu clinical reasoning. The research is now meeting it. A 2021 multicenter sham controlled RCT in Annals of Internal Medicine (Sun et al.) studied 440 men with moderate to severe chronic prostatitis and chronic pelvic pain syndrome across ten tertiary hospitals in China. Twenty sessions of acupuncture significantly outperformed sham, and the response held at the 32 week follow up. On the female side, a 2024 network meta-analysis in the Journal of Pain Research (Li et al.) found acupuncture more effective than Western medication for endometriosis related pain, CA-125 levels and response rate. We are not waving our hands. We have the data.
The third pillar is the neuroendocrine and emotional one, and this is where our medicine moves into territory other professions are not equipped to enter. Acupuncture modulates the HPA axis. It regulates vagal tone. It downshifts sympathetic overdrive in a pelvic bowl that has often been living in chronic fight or flight for years. CV 1 (Hui Yin; Meeting of Yin) is classically called a point of resurrection for the spirit. GV 1 (Chang Qiang; Long Strong) anchors the base of the Du mai and grounds what has been ungrounded. Our clients carry grief, trauma, shame and held breath in this region of the body. We meet all of it at once. The needles, the nervous system and the emotional terrain are not separate conversations in our medicine. They are one conversation.
So here is what I want for us. I want us to stop apologizing for the room we already occupy. I want us to refer when referral serves the client and to treat when treatment is ours to give. I want us to stand alongside pelvic PT with our own scope, our own evidence and our own ancient body of knowledge.
We are not late to this conversation. We started it.
Be the acu who knows how.
References
Cabrera Lacerda, L., da Silva Gomes, A., do Prado Augusto Reis, B., Carneiro, J. A., de Oliveira Cavalcanti, Z., & do Carmo Lopes Ferreira, C. (2022). Effectiveness of systemic acupuncture in the control of urinary incontinence following radical prostatectomy: A randomized clinical trial. Revista da Escola de Enfermagem da USP, 56, e20220135. https://doi.org/10.1590/1980-220X-REEUSP-2022-0135en
Jiang, T., Dong, Z. Y., Shi, Y., Zhou, Y. Q., Zhang, H. B., & Gong, Y. (2024). Efficacy and safety of acupuncture monotherapy or combined with pelvic floor muscle training for female stress urinary incontinence: A systematic review and meta-analysis. Frontiers in Medicine, 11, 1499905. https://doi.org/10.3389/fmed.2024.1499905
Li, H., Zhang, M., Li, J., Zhang, J., Zhang, Y., & Wang, S. (2024). Acupuncture and related therapies for endometriosis: A network meta-analysis of randomized controlled trials. Journal of Pain Research, 17, 3197–3216. https://doi.org/10.2147/JPR.S488343
Sun, Y., Liu, Y., Liu, B., Zhou, K., Yue, Z., Zhang, W., Fu, W., Yang, J., Li, N., He, L., Zang, Z., Wang, J., Zhao, J., Bao, T., Yan, S., Mao, X., Xu, H., Du, Y., Wang, L., . . . Liu, Z. (2021). Efficacy of acupuncture for chronic prostatitis/chronic pelvic pain syndrome: A randomized trial. Annals of Internal Medicine, 174(10), 1357–1366. https://doi.org/10.7326/M21-1814
Wan, O. Y. K., Cheung, R. Y. K., Law, M. P. M., Lee, L. L., Wang, R. C. C., & Chan, S. S. C. (2022). Effect of additional acupuncture to pelvic floor exercise on urinary incontinence: A randomized controlled trial. Neurourology and Urodynamics, 41(5), 1097–1108. https://doi.org/10.1002/nau.24918
Bio: Dr. Krystal Lynn Couture, DPT, LAc, founder of The Pelvic Acu, is an acupuncturist and physical therapist specializing in Pelvic Health. As a pelvic care acupuncturist, she brings to her practice a background steeped in both biomedical, TCM and holistic knowledge. She has an extensive formal background, with a Doctorate in physical therapy from Husson University as well as a Master of Science in acupuncture from the Institute of Taoist Education and Acupuncture. Krystal teaches Pelvic Care to Acupuncturists around the globe!