Chiropractic and Erections

More Chiropractic Needed for Men? What the Evidence Suggests — and the Research We Still Need

Can chiropractic or manual spine care affect erections?

It’s a question that comes up quietly — but consistently — in spine and pain clinics:

“My back feels better… and something else changed too.”

At the same time, erectile dysfunction (ED) is not a trivial symptom. It is a well-established neurovascular event and a recognized marker of cardiovascular risk, emphasized by organizations such as American Urological Association and Mayo Clinic.

So let’s be clear upfront:

There is currently no high-quality clinical trial evidence proving chiropractic care treats erectile dysfunction or increases penile blood flow.

What does exist — and what justifies careful research — is a pattern of case reports, mechanistic plausibility, and subgroup logic suggesting this may be worth studying in a very specific population of men.

This article lays out:

a focused, testable hypothesis

what the current evidence actually shows (and doesn’t)

why subgrouping matters

and why ChiropracticResults.com is calling for better case documentation and outcomes tracking

The core concept: erections are neurologic and vascular

An erection is not simply “more blood flow.”

It requires:

intact parasympathetic signaling (primarily S2–S4 spinal segments)

coordinated autonomic balance

sufficient arterial inflow and veno-occlusive function

This is why erectile dysfunction can arise from very different causes:

cardiometabolic disease

medication effects (SSRIs, antihypertensives, etc.)

depression and stress

hormonal imbalance

neurologic compromise

In short:

If nerve signaling is disrupted, vascular response can fail — even when arteries themselves are structurally intact.

Why the lumbosacral spine subgroup is biologically plausible

Lumbar stenosis and radiculopathy can involve pelvic-related nerve pathways

Lumbar spinal stenosis and radiculopathy are often described in terms of pain, numbness, and walking tolerance — but the same neural structures may also contribute to pelvic organ function.

Clinical literature (outside of chiropractic) has documented:

high rates of sexual dysfunction in men with lumbar pathology

mixed sexual outcomes following spinal surgery

differences between erectile function vs orgasm/ejaculatory outcomes

These findings don’t prove that spinal care improves erections — but they support the idea that sexual function and lumbosacral pathology can be linked in some men.

That distinction matters.

What evidence exists today? Mostly case reports — and that’s important to say out loud

1. Gonstead chiropractic case report (ED + chronic low back pain)

A peer-reviewed case report indexed in the Index to Chiropractic Literature describes a 53-year-old man with longstanding low back pain and erectile dysfunction who reported improved erectile function after approximately 8 weeks of Gonstead chiropractic care.

Why this matters

ED improved alongside improvement in spine-related symptoms

It directly motivates the hypothesis

Why it’s limited

single patient

self-reported outcomes

no control group

confounders not fully controlled

2. Asia-Pacific Chiropractic Journal case report (2023)

A 42-year-old man with severe low back pain, psychosocial stressors, and erectile dysfunction reported:

return of morning erections

normalization of erectile function

during a high-frequency chiropractic care plan.

Why this matters

Morning erections are often used clinically to suggest preserved neurovascular capability

Major confounders

antidepressant medication changes

lifestyle interventions

mental health improvements

The authors themselves emphasize the limits of inference.

3. Conservative spine care case report where erections did not improve

A published case report of an older male with lumbar stenosis showed:

improvement in orgasm and ejaculation

no improvement in erections

Why this matters

It prevents overclaiming

It highlights that male sexual function has distinct neurologic components

It refines the hypothesis toward subtypes, not blanket claims

4. Testimonials and clinic-published case stories

Some clinics publicly report ED improvement during chiropractic care.

These are:

signals, not evidence

valuable only if standardized, documented, and contextualized

This is exactly the gap ChiropracticResults.com exists to close.

The Primary Hypothesis (Subgrouped)

In men with erectile dysfunction and imaging or clinical evidence of lumbosacral radiculopathy or stenosis (or significant chronic low back pain with neurologic features), a course of chiropractic or manual spine care will improve patient-reported erectile function compared with a sham/manual-touch control.

Recommended primary outcome

International Index of Erectile Function (IIEF or IIEF-5/SHIM)

A validated, treatment-sensitive patient-reported outcome measure widely used in ED research.

The Secondary Hypothesis: blood flow (measured objectively)

In the same subgroup, penile hemodynamics measured by penile color Doppler ultrasound (e.g., peak systolic velocity) will improve compared with control.

Important nuance:

Penile Doppler is not a first-line test for all ED

It is typically used in selected or complex cases

Existing chiropractic literature does not currently measure penile Doppler outcomes

This hypothesis is forward-looking, not a claim of established effect.

Why sham control matters here

ED outcomes are highly sensitive to:

expectancy

stress reduction

relationship context

regression to the mean

A sham/manual-touch comparator is essential to determine whether observed changes exceed non-specific effects.

A critical safety and ethics note

Erectile dysfunction is widely recognized as a cardiovascular risk marker.

Consensus statements such as the Princeton guidelines and commentary from the American College of Cardiology emphasize that ED should prompt appropriate medical evaluation — not be treated as a purely quality-of-life issue.

Additionally:

new or progressive ED with bowel/bladder changes

saddle anesthesia

rapidly worsening neurologic symptoms

require urgent medical evaluation.

Call to action: we need better case reporting — not louder claims

If the profession wants to move beyond anecdotes, we need structured, reproducible case documentation.

What ChiropracticResults.com can collect (a minimum viable registry)

For ED cases associated with lumbosacral pathology:

Patient profile (de-identified)

age range

ED duration and severity (baseline IIEF/IIEF-5)

comorbidities (diabetes, hypertension, smoking, etc.)

medications (SSRIs, antihypertensives, PDE-5 inhibitors)

Spine and neurologic findings

imaging (if available)

sensory, reflex, motor findings

radicular patterns or neurogenic claudication features

Care plan

technique(s) used

frequency and duration

concurrent rehab or lifestyle changes

Outcomes at defined intervals

IIEF/IIEF-5 at baseline, weeks 4, 8, 12

pain and function outcomes

medication changes

adverse events

All publishable cases should follow CARE Case Report Guidelines to ensure transparency and interpretability.

What can responsibly be said — and what cannot (yet)

Reasonable to say

There is biologic plausibility for a specific subgroup

Current evidence consists mainly of case reports

This is a testable hypothesis worthy of controlled study

Not responsible to say

“Chiropractic cures ED”

“Spinal adjustments increase penile blood flow” as a general claim

Closing: help build the evidence, not the hype

If you’re a clinician who has observed changes in erectile function alongside objectively documented improvement in lumbosacral pathology — document it properly.

If you’re a patient — ED deserves a thorough medical evaluation and thoughtful care.

And if you care about advancing chiropractic beyond anecdotes, ChiropracticResults.com exists to turn individual observations into meaningful, interpretable outcomes.