Friday, 10 November 2017

There's Physiotherapy For That? ED edition

There is an ever growing market for erectile dysfunction (ED) treatment, some legitimate and others not so much. More men are experiencing difficulties and may not be aware of the variety of treatment options available to them. The purpose of this blog is to overview erectile dysfunction, causes/risk factors, the role of physical therapy and other treatment options.

Erectile dysfunction (ED) is defined as a persistent inability to achieve an erection or maintain the rigidity required for sexual intercourse (1). A complete examination should be completed by your medical provider to look at hormones, nerves, circulation and psychological status. The reason for a full work up is so that appropriate treatment is provided (1).

How do erections happen? Well you start off by thinking, smelling, seeing, touching or imaging something arousing. That signals the brain to send chemical messages to the blood vessels in the penis. These messages tell the arteries in the penis to open and relax so blood can freely enter into 2 long chambers within the penis. The veins in the penis close, allowing the penis to become rigid as blood flows in (2). This mark the first phase of getting an erection: the Vascular Phase (3).

The second phase is marked by the muscular phase. Once the pressure in the penis reaches a certain point, it triggers a contraction of the ischiocavernosus muscles (3) which is located in the first layer of the pelvic floor muscles. The contraction of this muscle maintains rigidity and plays a role in ejaculation (3). The bulbospongiosus muscle also located in the first layer of the pelvic floor muscles and it compresses the deep dorsal vein of the penis to prevent the outflow of blood from the engorged penis (4).

To summarize. Blood flows in after the brain signals the arteries to open. As blood fills in, it creates pressure on the veins so blood cannot escape. The muscles in the first layer of the pelvic floor contract to support and ensure blood stays in the penis.

Causes/Risk Factors for ED (1)
  • ·         Alcohol and/or nicotine abuse
  • ·         Drug use
  • ·         Diabetes
  • ·         Arteriosclerosis
  • ·         Hypertension (Blood pressure)
  • ·         Renal Failure (kidney failure)
  • ·         Hyperlipemia (Cholesterol)
  • ·         Nerve Damage
  • ·         Psychological factors

Physiotherapy Treatment

Physiotherapy treatment should be considered as part of first line treatment along with medications and hormone therapy (5). It is non-invasive, painless, easy to do and inexpensive form of therapy (1).

Physiotherapy treatment focuses on teaching a variety of exercises targeting the pelvic floor muscles and training them in various positions. The client will be sent home with an exercise program to do between treatment sessions.

If the exercises alone do not improving symptoms of ED, the therapist may supplement exercise by using biofeedback. This is when a probe is inserted into the rectum and hooked up to a computer that will graph and track the strength, endurance and speed of muscle contraction. The visual cue often times helps individuals connect more effectively with the contraction. Patients will sometimes say, “I don’t know if I am doing the exercises correctly.” The biofeedback will show if what you are doing is actually registering as a pelvic floor contraction.

In line with biofeedback, the therapist may also supplement biofeedback training with an electrical stimulation that further aids in the muscles contracting. In cases where a probe may not be indicated electrical stimulation can be done through pads that are placed externally.

Typical treatment protocols as seen in various clinical studies includes treatment for 12-15 weeks, with in-clinic visits, once a week  (1, 3, 4, 5).

In addition to exercises, I often work with my clients to implement lifestyle changes. If we can also address the risk factors that will certainly impact the experience of erectile dysfunction. A few key areas for change may include; diet, aerobic exercise, weight loss, sleep hygiene, smoking cessation, alcohol intake and psychological factors. Typically this is achieved through a multi-disciplinary approach.

Physiotherapy does not replace other forms of treatment.

Other therapies

Other forms of therapy may include: medications, vacuum devices, constriction bands (cock rings), counseling/sex therapy, intracavernosus injections, intra-urethral medications, topical therapy. If these fail to produce results the third line of treatment may include: vascular surgery or prosthetic implant. Of course, speak with your health care provider when considering which route to go.

If you are having problems in this area or know someone who is, please share.

The Pelvic Health Lady

  1.  Van Kampen et al. 2003. Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Physical Therapy 83L6): 536-542.
  2. WebMD. 2017. How the Penis Works: Erection and Ejaculation. Accessed on Oct 29, 2017 from
  3. Lavoisier et al. 2014. Pelvic floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Physical Therapy 94(12): 1731-1743.
  4. Dorey et al. 2004. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. British Journal of General Practice 54: 819-825.
  5. Dorey et al. 2005. BJU International 96: 595-597.


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