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 .