If I had to guess 99% of you did not, most doctors don’t even know it’s an option. The purpose of this article is to educate on what erections are, how the pelvic floor muscles are involved, risk factors/causes of erectile dysfunction (ED), and treatment options. As more men are experiencing this, it seems to be important to be educated about it and know what all the treatment options are.
About 10% of healthy men may be affected and these percentages increase when other medical conditions are present, such as diabetes (28%), blood pressure (hypertension) (15%), and heart disease (39%) (4). The true number of men experiencing this problem is difficult to estimate, especially because there are men that don’t report it to their doctor.
Anatomy of erections:
Within the shaft of the penis there are two long chambers called corpora cavernosa, which contain a network of blood vessels, pockets and tissue. In each chamber there is an artery that brings blood to the penis and several veins that allow blood to leave. There is also a network of nerves that carry information to the penis and out to the rest of the body (2). (WEBMD)
There are 2 superficial pelvic floor muscles that play a role in getting an erection and maintaining rigidity. The first muscle is called ishiocavernosus and the second is bulbospongiosus. The ischiocavernosus muscle activates to increase the intra penile pressure which assists in getting an erection and maintaining it. The bulbospongiosus muscle maintains rigidity by compressing the deep vein keeping blood inside the penis and is active in pumping during ejaculation.
So the first phase of getting an erection is all about blood flow and the second phase is about muscular contraction to keep the blood inside and aid in ejaculation.
Causes/Risk Factors (1)
- Alcohol and/or nicotine abuse
- Drug use
- Diabetes
- Arteriosclerosis
- Hypertension (Blood pressure)
- Renal Failure (kidney failure)
- Hyperlipemia (Cholesterol)
- Nerve Damage
- Psychological factors
- Prostate surgery
- Colorectal surgery
Treatment Options
One study I looked at listed treatment in 3 phases
First line treatment includes: hormones and/or pelvic floor physiotherapy and/or medication review (5)
- Physiotherapy is considered a first line treatment because it is noninvasive, it’s easy to do, it’s painless and inexpensive (1). Physiotherapy does not replace other medical therapies, it is meant to be an addition to the treatment plan.
Second line of treatment might include: oral therapy (medications), vaccum devices, constriction bands (rings), counseling/sex therapy, intracavernous injections, intra-urethral medication and/or topical therapy (5).
Third line of treatment might include: vascular surgery or prosthetic implant (5).
What might physiotherapy treatment look like?
- First is the assessment and physical examination, which includes but is not limited to the pelvic floor muscles.
- Therapy typically consists of pelvic floor muscle re-training exercises, or biofeedback or electrical stimulation or a combination of all three.
- Home exercises: you will provided with exercises to do at home between treatment sessions
- Typically sessions are once a week for 12-15 weeks (plus or minus a few sessions depending on individual needs)
What are some of the results of studies?
One study of 122 men with ED, underwent 20 sessions of physiotherapy that included electrical stimulation. Of those 122 men, 87% showed an improvement in intracavernous pressure, which is a major component of getting and maintaining an erection after treatment (3).
Another study of 55 men, half had physiotherapy treatment and lifestyle changes and the other half only lifestyles changes. The group receiving physiotherapy improved while the other group had very little change. After 3 months of treatment the group that had only lifestyles changes, got physiotherapy for 3 months. By the 6 month mark 40% of all participants returned to normal function, 34.5% had improved and 25.5% failed to improve (4).
Another study of 51 men, all underwent physiotherapy treatments for 4 months that also included biofeedback and electrical stimulation found, that 24 patients (47%) regained a normal erection, 12 patients (24%) had improved, 6 patients (12%) failed to change and 9 patients (18%) failed to complete treatment. They found individuals with psychological factors affecting their ED tended to not complete the treatment sessions and may warrant more counseling/sex therapy (1).
Success of treatment depends on a number of factors: completion of treatment and self motivation to complete exercises at home as prescribed, making changes in lifestyle factors, working with other medical providers to address health related conditions and address any psychological factors that may be impacting your participation in treatment and sexual activity.
When I see men, I can see the impact this is having on their quality of life. It’s not just the physical inability to engage in sexual activity by themselves or with their partner/spouses. There is an emotional and mental toll. Men often feel like they are less of a man, are frustrated and angry with their inability to provide pleasure to their spouse. This can lead to worry/anxiety about the impacts on the relationship in the future or actual separation/divorce. It can also lead to depression and losing sense of self.
Of course there is usually more to the story and every man’s story will be different. What is needed is a compassionate approach and creating a safe environment for men to talk about these impacts. As much as doctors would love to spend more time with their patients, often times they cannot to really understand what is happening. Seeing a physiotherapist can help fill in that gap and will work with your other medical providers to help you achieve your goals.
If you haven’t spoken with your doctor, now is the time to voice your concerns. Want to know more about how I can help, call the clinic and say “I want to do a meet and greet with Madelaine.” The office can schedule an in person or over the phone consultation to see if it is a good fit for you.
References:
- Van Kampen et al. 2003. Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Physical Therapy 83L6): 536-542.
- 2017. How the Penis Works: Erection and Ejaculation. Accessed on Oct 29, 2017 from https://www.webmd.com/erectile-dysfunction/how-an-erection-occurs.
- Lavoisier et al. 2014. Pelvic floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Physical Therapy 94(12): 1731-1743.
- 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.
- Dorey et al. 2005. BJU International 96: 595-597.