Online Health Chat with Brenda Powell, MD, Integrative Medicine Physician, and Lead Acupuncturist Jamie Starkey, LAc, from Cleveland Clinic’s Center for Integrative Medicine
February 1, 2012
Cleveland_Clinic_Host: Studies estimate that more than 40 percent of American women have some form of sexual dysfunction, from low desire to painful intercourse. Many women are embarrassed to express their sexual desires and often are reluctant to seek help for problems in the bedroom.
Clinical studies have shown acupuncture to be a beneficial treatment and useful complementary therapy for sexual dysfunction and to be helpful in increasing a low libido. Acupuncture has an effect on various physiological systems in the body that are involved in sexual response.
Acupuncture, a 3,000-year-old form of traditional Chinese medicine, draws on the belief that an energy called Qi (pronounced “chee”) circulates throughout the body, from the top of the head to the soles of the feet. When we experience good health, this energy flows unobstructed along pathways in the body called meridians. Each meridian is believed to be connected to a specific organ system, and when an energy flow is disrupted by a disease or an injury, illness or pain occurs. Acupuncture is then used to balance the flow of Qi and stimulate the body’s natural ability to heal.
According to Western and Eastern medicine, there are many causes of low libido. It is important to identify the cause in order to address and improve sexual desire. According to Western medicine, there are many psychological, organic, prescriptive medicine side effects, and even lifestyle factors that can cause a low libido. Whereas, Eastern medicine is more abstract and looks for imbalances of Qi to determine lack of desire, lack of arousal, failure to orgasm, over thinking, or painful intercourse.
Dr. Powell and Jamie Starkey will address both Western and Eastern medicine perspectives on helping to identify potential causes of sexual dysfunction and to find ways to enhance your libido.
Additionally, Ms. Starkey will be available to answer general acupuncture questions, such as what happens during an acupuncture treatment, what it feel like, will it hurt, how often you should be treated with acupuncture, and more.
About the speakers:
Brenda Powell, MD, Integrative Medicine Physician
Dr. Brenda Powell is staff at Cleveland Clinic in the Center for Integrative Medicine and associate clinical staff at Case Western Reserve University School of Medicine. She received her medical degree from Duke University School of Medicine in 1988 and completed residency training in family medicine at Duke University Medical Center in 1991. She completed the Harvard Macy Physician as Teacher Fellowship at the Harvard School of Education in 1999. She certified in travel medicine through the International Society of Travel Medicine in 2007.
She began her career in private practice in family medicine in California. She was with Family Medicine at Case Western Reserve School of Medicine from 1995 to 2000. During this time she developed the curriculum for women’s health training and the women’s health fellowship, taught electives in the medical school on travel medicine, and served as pre-doctoral director in family medicine. Dr. Powell has been with the Cleveland Clinic since 2000 in family medicine and travel medicine.
Dr. Powell devotes her practice to integrative medicine at the Center for Integrative Medicine in the Cleveland Clinic Wellness Institute. She’s currently seeing patients at Cleveland Clinic’s Lyndhurst Campus. Dr. Powell now sees patients at the Main Campus on Wednesdays.
In addition to seeing integrative medicine patients, Dr. Powell provides consultations in the Travel Clinic at the Beachwood Family Health Center.
Jamie Starkey, LAc, Lead Acupuncturist, Center for Integrative Medicine
Jamie earned a bachelor’s degree in biology at the University of Toledo and a master’s degree in acupuncture at the American Institute of Alternative Medicine. She further enhanced her clinical training by completing a clinical internship at Guang AnMen Hospital in Beijing China, Acupuncture and Moxibustion Outpatient Department, an affiliate of the China Academy of Traditional Chinese Medicine. She is a Diplomate of Acupuncture, National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), and holds her acupuncture license from the Ohio State Medical Board. Additionally, she is a Level II Reiki Practitioner. Jamie has served as the Secretary of the Ohio Association of Acupuncture and Oriental Medicine (OAAOM) from December 2006 to December 2008 and has been a member of the Ohio Association of Acupuncture and Oriental Medicine (OAAOM) since 2005.
Jamie offers acupuncture at the Cleveland Clinic with a focus on women’s health, oncology, acute/chronic pain management, sports-related injuries, stress-related disorders, and acupuncture clinical research. “I take great pride in being a clinician of traditional Chinese medicine. I strive to help patients discover the ability their body has to heal itself when properly supported and brought back into a balanced state of health and wellness.”
To schedule an appointment with Integrative Medicine Physician Brenda Powell, MD, Jamie Starkey, LAc, Lead Acupuncturist, or other Integrative Medicine services, call Cleveland Clinic’s Center for Integrative Medicine at 216.986.HEAL (4325).
Visit clevelandclinic.org/integrativemedicine to learn more about how our Center for Integrative Medicine can help you.
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic specialists Brenda Powell, MD, and Jamie Starkey, LAc. We are thrilled to have them here today for this chat. Let’s begin with some of your questions.
Jericho: What is acupuncture?
Jamie_Starkey_LAc: Acupuncture is a 3,000-year-old form of Traditional Chinese Medicine whereby tiny hair-thin needles are placed in specific points of the body to induce a therapeutic effect.
r_and_r: How does acupuncture work?
Jamie_Starkey_LAc: In traditional Chinese medicine, our approach to health can be fundamentally broken down into the universal principle of yin and yang. As a clinician of Eastern Medicine, I determine where imbalances of yin and yang may be. In Eastern Medicine, we draw from the idea that an “energy” called Qi (pronounced “chee”) flows through our bodies along invisible pathways called meridians. These meridians energetically connect to various organ systems (such as the kidneys, liver, spleen, lungs, heart, etc.).
Jamie_Starkey_LAc: When the Qi is flowing smoothly, with no obstructions, and when there is a proper amount of Qi flowing in the body, we are in a perfect state of health and wellness. None of us is ever “perfect,” unfortunately. There is always an imbalance of Qi, either by way of excess (Qi is stagnated in a meridian) or there can be a deficiency of Qi (not enough Qi in the body). When this imbalance occurs, we manifest as pain, illness or injury. Acupuncture is a modality that can balance the flow of Qi and support the body’s natural ability to heal.
Jamie_Starkey_LAc: Now from a Western medical perspective, there are a lot of great randomized control trials out there showing the efficacy of acupuncture, in addition to many studies showing the mechanism of action. We see that acupuncture has a very strong influence over the nervous system by way of influencing neurotransmitters and neurohormones. Essentially I am using needles to engage in the peripheral and central nervous systems. Imaging studies show there to be a release of chemicals from the brain, such as endorphins (natural pain killers). Animal studies have revealed changes in levels of serotonin, dopamine (chemicals that influence mood). We see that acupuncture works as an anti-inflammatory agents (just like an NSAID, Ibuprofen). There are also studies demonstrating acupuncture’s influence over the immune system and endocrine system.
Jamie_Starkey_LAc: Acupuncture is one of the most highly funded therapies by the NIH’s National Center for Complementary and Alternative Medicine, and there are many well designed studies that have been done from highly regarded medical institutions published in respected peer reviewed journals. Certainly, there needs to be continued research, as there are still a lot of unanswered questions.
harper034: Can you be treated for more than one thing at a time with acupuncture?
Jamie_Starkey_LAc: Absolutely. Treating multiple conditions is something I commonly do in the Clinic. When a patient comes in with a main complaint, that is one small piece of a very large jigsaw puzzle. I have to look at the patient as a whole, i.e. a holistic approach. If there are other conditions ailing the patient, that must be taken into consideration as well, and addressed with acupuncture if it falls within the scope of treatment.
jojo: What conditions are treated?
Jamie_Starkey_LAc: I see a myriad of conditions that range from acute/chronic pain conditions such as headache, migraines, low back pain, neck pain, knee pain, rheumatoid arthritis pain, etc.; women’s health problems such as low libido, hot flashes, irregular menstruation, painful menstruation, infertility, morning sickness; psych disorders such as depression, anxiety, insomnia; symptom management of side effects due to chemotherapy and radiation such as fatigue, peripheral neuropathy (numbness pain of extremities), xerostomia (dry mouth), nausea, vomiting. You can find a list of conditions the World Health Organization endorses by going to their website: http://www.who.int/about/en/
stand_up: What is the theory behind integrative medicine?
Brenda_Powell_MD: It takes a healthy mind, body and spirit to feel well. We have a larger toolbox to pull from in treating different ailments. By definition, integrative means pulling together modalities that have evidence-based research data behind them to support its effectiveness.
number_one: Is integrated medicine strictly holistic or does it include 'regular' medicine?
Brenda_Powell_MD: I am a family physician, so I can use 'regular' medicine. However, because I am in a consulting position, I prefer that conventional medicine be done by the primary care physician. I will initiate medical care if I feel it is necessary. This is unique to Cleveland Clinic, that we integrate both aspects. Many integrated medicine physicians are not MDs and are not affiliated with any hospital and cannot prescribe medications.
jondo: Are there other alternative/integrative methods for treating low libido besides acupuncture?
Brenda_Powell_MD: If low libido is a result of perimenopause or menopausal issues, we use supplements for this. Some supplements can also be used to help the physical effects of stress, which can have an impact on libido. People have sleep disorders and are too fatigued to have a healthy libido. I can help them with sleep. We also provide holistic psychotherapies.
Brenda_Powell_MD: A lot depends on the cause of the decreased libido.
Special_Me: What would an appointment in Integrative Medicine look like for reduced libido? Is acupuncture always included?
Brenda_Powell_MD: We get a detailed history, including all medications, supplements and current diagnosis, review labs, and order labs as needed. A big part of the history will focus on the GYN part of the history and factors that may decrease libido -- medical and emotional. You always refer to acupuncture, because it is so effective. My job is to make sure the patient is physically well for sexual activity and that there is nothing medically interfering with their libido.
Causes of Low Libido
dododo: What causes low libido from a Western perspective?
Brenda_Powell_MD: There are psychological factors:
- Not feeling close in your relationship
- Sexual trauma
Brenda_Powell_MD: There are organic factors:
- Hormone imbalances: thyroid, decreased testosterone, low progesterone, increased estrogen
Brenda_Powell_MD: There are lifestyle factors:
- Modern life (When exactly do couples have sex with busy work schedules? Stress! Fatigue!)
- Dull, boring sex life (couples doing the same thing for 30 years)
Brenda_Powell_MD: Prescriptive medication will oftentimes have an adverse effect on libido.
Brenda_Powell_MD: AEs: antihypertensives, antidepressants, opiates (Opiates can alter male hormones, lower testosterone after prolonged exposure to high doses.)
do_it_again: What causes low libido from Eastern perspective?
Jamie Starkey LAc: As a clinician of Eastern Medicine, my diagnoses are often abstract, likely to make no sense to Western clinicians but will make perfect sense to anyone who practices Eastern Medicine. I look at an array of various symptoms that may not intuitively correlate to low libido and tease out patterns, of which I use to determine a Traditional Chinese Medicine (TCM) diagnosis. Examples of TCM for low libido could be:
- Imbalance of Qi in heart and kidneys, KI (lack of desire, lack of arousal)
- Kidney yang deficiency (example in males: low libido, weak ejaculation, impotence, seminal emission, low sperm count, slow motility, various yang deficiency symptoms like coldness, fatigue, pale bright face, copious clear urine)
- Phlegm-damp accumulation
- Jing deficiency
- Liver Qi stagnation (failure to orgasm)
- Heart/spleen deficiency (over thinking)
- Liver yin/blood deficiency (mostly seen in women)
- Blood stagnation (painful intercourse)
lepton197: What effect does age (e.g., 80) have on libido?
Brenda_Powell_MD: Aging should not mean that you lose your libido, but with age comes low hormonal levels and chronic disease, which can affect your libido. If loss of libido is an issue to an 80-year-old, we would take it seriously in a consultation.
good_job: Can acupuncture work for low libido in both women and men?
Jamie_Starkey_LAc: Most of the studies I have seen in terms of Western science are based on low libido for females, but in my practice I address low libido in both males and females, especially if there are lifestyle factors involved, (i.e., stress) or if low libido is a side effect of medication (i.e. antidepressants or pain medication).
Jamie_Starkey_LAc: I also recommend patients see an MD as well to rule out any organic factors (low testosterone, Diabetes, etc.). Dr. Powell mentioned earlier to be sure they are being medically managed appropriately as well.
missing_out: Does acupuncture treat causes of low libido such as improving diabetes so erectile dysfunction lessens or improving depression symptoms?
Jamie_Starkey_LAc: Yes and no. Acupuncture can certainly be used to treat depression and be used as an adjunct to diabetes. Oftentimes with diabetes, I am managing complications of the disease (i.e., peripheral neuropathy), but I do not treat the diabetes directly.
how_much_more: I’ve been on antidepressants for several years, and it has seriously decreased my libido. Changing meds is not an option, since it took a long time to find the right combination that works for me. Is there anything else I can try?
Brenda Powell, MD: Yes. We can make sure that there are no problems with the thyroid or nutrition or continued anxiety, sleep disorders, vitamin deficiencies, etc. Holistic psychotherapy is also a good option.
Jamie_Starkey_LAc: From an acupuncture perspective, I would address the side effects of the antidepressant (in this case low libido), as well as the depression itself. Acupuncture gives a boost in mood by promoting the release of 'feel good chemicals' from the brain, such as endorphins.
prt54: With women (and men?), low libido could be linked to low self-image—not feeling attractive enough, etc. Does acupuncture help with these kinds of feelings?
Jamie_Starkey_LAc: With self-esteem issues, I like to refer to a mental health professional.
low_down: Does acupuncture help treat low libido caused by medications?
Jamie_Starkey_LAc: Yes. In addition to antidepressants, opiates and antihypertensives are common prescriptions that can cause low libido. Pain, depression and hypertension are commonly addressed with acupuncture. If you can decrease the need for medication, then the side effects lessen.
open_book: Ever since I went through menopause, I haven’t had much interest in sex. I don’t want to go on hormone replacement. Can acupuncture help with this?
Jamie_Starkey_LAc: Yes. It helps with all menopausal symptoms - hot flashes and low libido specifically. There are numerous clinical trials which support acupuncture’s efficacy to address menopausal symptoms.
Brenda_Powell,_MD: We can also consider phytoestrogen or phyto progesterones and DHEA. There has been some research with two herbs’ potency, wood (Muira Puama) and Maca (Lepidium Meyenii), that look promising.
drink_up: How can acupuncture help?
Jamie_Starkey,_ LAc: I treat patients at the root level of disharmony. If patients are having low libido due to menopause, I work towards strengthening the kidney Qi, or you can think of it from a Western sense as regulating hormones that may be out of balance during that transition into menopause. If you are experiencing lack of arousal due to stress, I aim to strengthen the Qi of the heart and pericardium while making sure the liver meridian is free of any Qi stagnation. From a Western sense, we are engaging in the body’s parasympathetic nervous system, which influences the relaxation response, helping patients to deal with stress, induce calm, working towards stopping that fight or flight response (which we all find ourselves in when we’re stressed out!).
Jamie_Starkey,_LAc: Acupuncture is effective in treating depression, to enhance mood by influencing the limbic system. The brains releases endorphins and dopamine (brain chemicals that enhance mood). When your mood improves, you desire for sex becomes greater.
Brenda_Powell_MD: Acupuncture can treat various conditions (such as pain or mild depression) as an alternative to medication, thereby eliminating side effects of medication.
Brenda_Powell_MD: When I look at the list of organic, psychological and even lifestyle factors that cause low libido, I see things that can be addressed with a multidisciplinary approach, of which I’m a huge proponent. For example: use acupuncture in combination with conventional counseling or psychotherapy to address stress, relationship or body image issues, or even past sexual traumas. As you progress in your acupuncture sessions, be sure you continue to see your physician on a regular basis to attempt to wean off of your medication that may be causing the side effect of low libido.
clara: You mentioned that you look at the tongue in the initial exam - why?
Jamie_Starkey_LAc: In traditional Chinese medicine, the tongue is an integral part of diagnosing a patient. There are a lot of things that we look at on the tongue itself that tell us a lot about what is going on in the body that help us formulate a diagnosis. We look at things like the color of the tongue body, how wet or dry it is, the coating, the color of the coating, teeth marks, fissures, etc. I observe different parts of the tongue as well. Depending on what we see, it helps us to hone in on traditional Chinese Medical diagnosis.
ggh: What happens during a treatment?
Jamie_Starkey,_LAc: During your initial visit, I will go through a very detailed intake form that asks you questions about every aspect of your health, ranging from stress, diet, sleep, pain, bowel movements, menstrual cycle, etc. I take a holistic approach when seeing patients, so every little thing matters when I’m trying to diagnose from an Eastern medical perspective. Even if you feel that it does not relate to your main complaint, it definitely matters to me.
graver9: Does the acupuncture treatment differ depending on the cause of a decreased libido?
Jamie_Starkey,_LAc: Yes. No two patients are treated the same way. The points in which I would insert a needle may be different for each patient. The diagnosis from a traditional Chinese medical perspective, which could be manifesting as a low libido, can be different for each patient.
brand95: Where do you put the needles for this type of acupuncture? Are they ever put into a person's sexual organs/areas?
Jamie_Starkey_LAc: There are certainly acupuncture points in that area, but they are rarely needled. Usually, the needles are placed in the limbs, abdomen and perhaps in the ears or on the head. In my clinical experience, I have never needled those areas.
bee_bee: What does it feel like, will it hurt?
Jamie_Starkey,_LAc: Acupuncture generally should not be painful. The needles are incredibly fine and slender, about the size of a strand of hair. You may or may not feel an initial prick, or a tickle, but most patients feel very little. You should feel a Qi sensation that could be described as a deep throb, an electrical sensation, a light feeling of warmth, but you really should not feel pain. If you feel discomfort, TELL ME!!!
U2canrise: How many treatments will you need before you see results?
Jamie_Starkey_LAc: It is variable. Patients have variable responses. I generally recommend 5 to 10 treatments as a course, on a one week interval. I then reassess after a full course of treatment. Some patients respond after a couple of treatments, but more respond after several visits because acupuncture has a cumulative effect.
Deedee03: How soon after treatment begins are results usually noticeable?
Jamie_Starkey_LAc: See answer to U2canrise’s previous question
Deedee03: You said 5 to 10 treatments are generally recommended for results. Do patients tend to need repeated treatments over time or for "maintenance"?
Jamie_Starkey_LAc: It depends. Generally maintenance is a good idea, whether it be once a month or every few months, or even just as needed.
jandy: Does my insurance cover acupuncture?
Brenda_Powell_MD: Insurance coverage is variable. I know for certain that Medicare and Medicaid do not cover acupuncture. Patients can call their insurance company directly or speak to someone at the Center for Integrative Medicine. We have a wonderful team of experts who could better answer those questions.
Acupuncture and Other Health Concerns
U2canrise: Do you feel acupuncture will help with the after-effects of Graves disease that distorted the eyes (bulging & one larger than other)?
Jamie_Starkey_LAc: Exophthalmos (bulging eyes) secondary to Grave's Disease, in my opinion, falls well outside of the scope of acupuncture. I do not see patients for this condition, nor do I believe acupuncture is the proper treatment option for patients with this condition. I did a quick literature search and there are no studies that can support acupuncture's efficacy in the treatment of this.
U2canrise: Do you think acupuncture will help with the following: asthma & allergy symptoms such as runny nose, itchy throat, coughing, post nasal drip, etc.? If so, how much & for how long should you do acupuncture?
Jamie_Starkey_LAc: In my practice I find patients have overall decreased allergy symptoms, decreased use of medicine/inhalers. I recommend patients starting acupuncture treatment approx 1-2 months prior to their worst allergy season, once a week for approximately 5-10 visits (recommendation is general and would be adjusted per patient).
- lower daily rhinitis scores
- more symptom free days
- One study showed acupuncture worked as well as an antihistamine in improving symptoms, longer lasting.
Daniel K. NG et al; Pediatrics 2004; 114; 1242-1247
Nataliya M. Kushnir; Immunol Allergy Clinic N Am 31(2011) 601-617
hello_hello: My husband has erectile dysfunction. Would acupuncture be helpful?
Jamie_Starkey_LAc: If organic cause of ED (ex: prostatitis), I would refer to urologist for evaluation. If ED is due to stress/anxiety/side effects of medications mentioned in the webchat, then I would address the root condition with the goal of improvement of ED as secondary benefit. Data from research trials is scarce due to poor methodology and design of studies.
pplona: Can acupuncture be helpful for prostate pts/erectile dysfunction?
Jamie_Starkey_LAc: See comments above.
U2canrise: How will or does acupuncture help with menopause or pre-menopausal symptoms?
Jamie_Starkey_LAc: Helps with menopausal/perimenopausal symptoms especially hot flashes, insomnia, low libido
songcanary: I notice that you mention acupuncture having an antihistamine effect. I have multiple food allergies, some of which result in hives and others in GI symptoms. Would acupuncture be helpful for food allergies?
Jamie_Starkey_LAc: Some of the clinical studies looking at mechanism of action have identified acupuncture’s influence over histamine reaction. In my opinion, I feel food allergies fall outside of the scope of an acupuncturist and I do not treat patients for food allergies. Hives and other GI symptoms will sometimes improve as a side benefit but I generally do not address food allergies specifically. Given the nature and sometimes severity of allergic reactions, it is best that food allergies be medically managed by an MD and if symptoms are still an ongoing problem, using acupuncture as an adjunct. There are no clinical studies out there supporting the use of acupuncture for food allergies.
Cleveland_Clinic_Host: I am sorry to say that our time with Dr. Powell and Ms. Starkey is now over. Thank you both for participating in today’s chat.
To schedule an appointment with Integrative Medicine Physician Jamie Starkey, LAc, Lead Acupuncturist, or other Integrative Medicine services, call Cleveland Clinic’s Center for Integrative Medicine at 216.986.HEAL (4325).
Visit clevelandclinic.org/integrativemedicine to learn more about how our Center for Integrative Medicine can help you.
You may request a remote second opinion from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit my.clevelandclinic.org/online-services/myconsult.