How A Physical Therapist Can Help Treat Erectile Dysfunction

I’m a physical therapist who specializes in treating the pelvic floor. This includes issues with the bladder, bowel, reproductive organs, and pain in the lower back, SIJ, and hips.

One population that I treat at my clinic is men with Erectile Dysfunction (ED). Erectile dysfunction affects millions of men globally and is becoming more prevalent due to lifestyle factors and aging. Although medications and devices are often sought for quick relief, Pelvic Floor Physical Therapy (PFPT) offers a unique, non-invasive treatment option that addresses ED by strengthening and reconditioning the pelvic floor muscles, which are integral to erection quality.

This article explores how PFPT works, the role of pelvic floor muscles in erections, the types and causes of ED, and why PFPT should be considered a first-line approach to managing ED.

What Is an Erection? The Anatomy and Physiology

An erection results from a complex interaction of neurological, vascular, and muscular systems. It begins in the brain, where arousal triggers signals that increase blood flow to the penis. Blood fills the corpus cavernosum, creating penile rigidity. However, the pelvic floor muscles—particularly the ischiocavernosus and bulbocavernosus—play an equally important role in sustaining this rigidity.

Key Muscles

The ischiocavernosus helps stabilize the erection, while the bulbocavernosus increases intracavernous pressure, helping to maintain blood flow by compressing veins that would otherwise allow blood to drain. Research shows that these muscle contractions reduce venous outflow, thus aiding in erection duration and firmness.

Pelvic Floor Functionality

A well-conditioned pelvic floor enhances this pressure, allowing sustained erections. However, dysfunction in these muscles can compromise blood flow regulation, making it difficult to maintain an erection.

A healthy pelvic floor not only supports erections but also contributes to arousal and orgasm, highlighting its role in sexual function. Studies have shown that both hypertonic (high tone and tight) and hypotonic (low tone and loose) pelvic floor muscles can disrupt this balance and contribute to ED .

Understanding Erectile Dysfunction and Its Types

Erectile Dysfunction (ED) manifests in several ways, each with unique causes and implications for treatment:

Organic ED

Often the result of physical health conditions, organic ED is linked to issues like cardiovascular disease, diabetes, or nerve injuries. Vascular health is particularly relevant, as restricted blood flow prevents an erection.

Additionally, conditions like diabetes can damage nerves essential for initiating and maintaining an erection.

Psychogenic ED

This form of ED arises from psychological factors, including stress, anxiety, or depression. Men with psychogenic ED may still experience spontaneous erections in non-sexual contexts, as the issue is more related to mental and emotional states.

Mixed ED

A combination of organic and psychogenic causes, mixed ED is common in men with chronic health conditions or those who experience psychological impacts as a result of physical limitations.

Each type of ED has its own contributing factors, with organic causes often overlapping with cardiovascular and neuromuscular health. Physical therapy interventions, particularly pelvic floor therapy, can help address some of these underlying physical issues, especially those stemming from neuromuscular and vascular dysfunction.

Treatment Options for Erectile Dysfunction

ED treatments vary widely and are tailored to the underlying causes:

Medication

Oral medications such as sildenafil (Viagra) and tadalafil (Cialis) are commonly prescribed and effective in many cases, but they are not suitable for everyone, particularly men with cardiovascular issues. These medications can be expensive over time and forgetting to fill a prescription or stopping to take a pill can be a mood-killer.

Injections and Vacuum Devices

For some, intracavernous injections and vacuum pumps offer an alternative. However, they are invasive or uncomfortable, leading to low adherence over time.

Penile Prostheses

As a last-resort option, prostheses have high success rates but come with surgical risks such as infection and mechanical failure .

Psychotherapy

For those with psychogenic ED, therapy can address anxiety, depression, or relational issues that interfere with sexual function. Seeing a therapist one on one, attending group sessions, or joining a support group can be great options.

Pelvic Floor Physical Therapy is emerging as a valuable, non-invasive treatment option, especially for ED cases associated with pelvic floor dysfunction or vascular concerns. By strengthening, coordinating, and relaxing the pelvic floor muscles, PFPT can help improve erectile function naturally and sustainably.

How Pelvic Floor Physical Therapy Can Help

PFPT has shown great potential as a non-invasive treatment for ED, particularly in cases of pelvic floor dysfunction. Research supports the efficacy of PFPT in enhancing erectile function by optimizing the pelvic floor’s performance. Here’s how PFPT addresses ED:

Pelvic Floor Muscle Training (PFMT)

PFMT involves exercises that strengthen the pelvic floor muscles, which play a critical role in sustaining erections. A study by Dorey et al. found that after three months of PFMT, 40% of participants reported full recovery of erectile function, highlighting the efficacy of strengthening these muscles.

Biofeedback and Electrical Stimulation

These techniques help men become more aware of their pelvic muscles, improving control. Biofeedback allows for precise engagement of the ischiocavernosus and bulbocavernosus muscles, which are essential for maintaining an erection. Your physical therapist can use a variety of techniques for this including ultrasound or electrodes and screens to visualize the muscle contraction; use of a towel or hand at the perineum (area between the testicles and anus) to feel to contraction; or visual feedback using a mirror or simply watching the movement when you engage the muscles.

Coordination and Relaxation Training

For those with hypertonic muscles (tight muscles that are difficult to disengage), relaxation techniques alleviate tension, reducing pain and improving sexual function. Research by Rosenbaum et al. demonstrated that relaxation training reduces discomfort and optimizes function in men with high muscle tone .

Supporting Vascular Health

Pelvic floor muscle strength also aids in vascular function, as strong contractions of the ischiocavernosus and bulbocavernosus compress blood vessels and increase intracavernous pressure, mimicking the natural physiological response during arousal.

Benefits of Choosing Pelvic Floor Physical Therapy

PFPT is a low-cost, low-risk option that provides a sustainable solution for ED without medication. It offers long-term benefits for both erectile function and overall pelvic health:

• Non-Invasive and Conservative: Unlike surgical or pharmacological options, PFPT is entirely non-invasive.
• Long-Term Improvement: Strengthening pelvic floor muscles offers lasting benefits, unlike medications or devices that only provide temporary solutions.
• Medication-Free: PFPT is a suitable alternative for those who prefer to avoid medications due to potential contraindications with cardiovascular health.
• Enhanced Confidence and Psychological Well-being: Improved muscle strength and function often lead to better self-confidence, reducing psychological barriers to sexual function.

The Role of Cardiovascular Health in ED

Cardiovascular health is crucial for ED management, as an erection depends on sufficient blood flow. Research has demonstrated that men with cardiovascular disease face a higher risk of ED due to shared risk factors like obesity, hypertension, and poor physical fitness .

Studies have shown that improving cardiovascular health through aerobic exercise, especially at moderate to vigorous intensities, can significantly enhance erectile function. A systematic review by Silva et al. suggests that regular cardiovascular activity improves reported erectile function by enhancing blood flow, reducing inflammation, and supporting vascular health. Exercise modalities such as brisk walking, swimming, and cycling improve circulation and lower blood pressure, directly benefiting ED symptoms and cardiovascular health alike.

How Physical Therapists Can Support Cardiovascular Health and ED

Physical therapists are uniquely positioned to support men who face barriers to cardiovascular exercise due to neuromusculoskeletal issues. Addressing limitations such as low back pain, arthritis, or joint dysfunction can enhance exercise tolerance, promoting better cardiovascular health and reducing ED risk. Here are some ways physical therapists contribute:

• Mobility and Flexibility Training: By improving joint mobility and muscle flexibility, physical therapists enable patients to engage in cardiovascular activities without pain or restriction.
• Strength Training and Postural Correction: Weakness in core and postural muscles can lead to pain and fatigue during exercise. Physical therapists target these areas to improve stamina and comfort, allowing for more sustained physical activity.
• Functional Rehabilitation: For men recovering from injuries or surgeries, physical therapy provides structured rehabilitation, gradually increasing activity levels in a safe, effective manner.
• Patient Education: Physical therapists educate patients on safe exercise techniques and strategies to maintain an active lifestyle despite neuromusculoskeletal limitations.

By addressing these issues, physical therapy promotes a more active lifestyle, ultimately supporting cardiovascular health, which can help prevent or improve ED.

Conclusion

Erectile dysfunction is a multifactorial condition that requires a holistic approach to treatment. Pelvic Floor Physical Therapy is an effective, non-invasive, and sustainable method to address ED, leveraging the body’s natural musculature and blood flow mechanisms.

For men seeking a proactive, conservative approach to managing ED, PFPT offers an empowering and research-backed solution.

If you are located in the Piedmont area of NC, contact me to set up an appointment to see how we can improve your quality of life together!

Share this blog with friends, family, and your healthcare providers to spread the word and help those who are in need get the help they deserve.

Patient Resources

If you’re interested in learning more about ED and treatment options or pelvic floor physical therapy, check out these great reads that have been instrumental in my patient care:

Harm-Ernandes I. The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms. Scottsdale, AZ: Proactive Pelvic Health; 2020.

Gronski S. Pelvic Pain: The Ultimate Cock Block. 2nd ed. Asheville, NC: Dr. Susie G; 2020.

Allingham C. Prostate Recovery MAP: Men’s Action Plan. 3rd ed. Thirroul, Australia: Active Living International; 2018.

Louw A, Hilton S, Vandyken C. Why Pelvic Pain Hurts: Neuroscience Education for Patients with Pelvic Pain. Minneapolis, MN: OPTP; 2013.

References

1. Allingham C. Prostate Recovery MAP: Men’s Action Plan. 3rd ed. Thirroul, Australia: Active Living International; 2018.
2. Gronski S. Pelvic Pain: The Ultimate Cock Block. 2nd ed. Asheville, NC: Dr. Susie G; 2020.
3. Harm-Ernandes I. The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms. Scottsdale, AZ: Proactive Pelvic Health; 2020.
4. Louw A, Hilton S, Vandyken C. Why Pelvic Pain Hurts: Neuroscience Education for Patients with Pelvic Pain. Minneapolis, MN: OPTP; 2013.
5. Myers C, et al. Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review. Physiotherapy. 2019;105(2):235-243.
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