The male pelvic floor is made up of two layers: the deep pelvic floor muscles and the superficial pelvic floor muscles.  It is the superficial pelvic floor muscles, ischiocavernosus and bulbocavernosus, that play an important role in erectile function. 

 

The bulbocavernosus muscle encircles the base of the penis, and has two key functions in erectile function: 

1) It prevents blood from escaping the erect penis by exerting pressure on the deep dorsal vein

2) It contracts during ejaculation

 

The ischiocavernosus muscle attaches from the ischial tuberosity to the pubic ramus, and its contraction leads to an increase in intracavernous pressure and penile rigidity.  

 

Weakness of these muscles can lead to a poor ability to maintain an erection, reduced firmness of erection, and premature ejaculation. The pelvic floor muscles can become weak due to ageing, constipation and straining, heavy lifting, low back pain, or lack of use (such as not being sexually active).

 

Pelvic Floor Muscle Dysfunction is just one of the multifactorial contributors to erectile dysfunction. Effective management of erectile dysfunction involves a detailed and thorough assessment, medical intervention, and psychological intervention. 

 

A systematic review published this year found that pelvic floor muscle training appears effective in treating erectile dysfunction and premature ejaculation in a non-neurological, non-post surgical population¹. The review found that 3-4 months of pelvic floor muscle training (+/- electrical stimulation or biofeedback) led to erectile dysfunction cure rates of 35-47%, and premature ejaculation cure rates of 55-83%.¹

 

Pelvic floor muscle training can also be effective in the post-prostatectomy patient population.  In a randomised controlled trial, Geraerts et al.² found pelvic floor exercises effective in reducing erectile dysfunction after radical prostatectomy.  They studied the efficacy of a 3-month supervised pelvic floor muscle training program commenced at 12 months post radical prostatectomy, and found statistically and clinically significant benefit in the pelvic floor exercise group, with results maintained at long term follow up.  In addition, they also found that pelvic floor exercises had a beneficial effect on climacturia (incontinence with orgasm). 

 

For pelvic floor exercises to be effective, an intensive training program must be completed. Best results will be achieved when men complete an individualised training program under the guidance of a post graduate trained Pelvic Floor Physiotherapist.  Optimal strength gains will be achieved after 4-6 months.

 

Pelvic floor exercises should be considered an important part of the multidisciplinary treatment for men seeking long-lasting resolution of erectile dysfunction of a non-neurological or surgical origin.  Additionally, for men already undertaking other forms of therapy for erectile dysfunction, pelvic floor exercises may further enhance the efficacy of these treatments. 

 

Pelvic floor exercises have no side effects, are easy to do, cost effective, and have other benefits such as preventing or treating urinary incontinence or bowel dysfunction.  Really, you’d be crazy if you didn’t try them!