Erectile Dysfunction

Welcome, Bestie. Today, I wanted to chat about Erectile Dysfunction (ED). ED is a fairly common issue within the male population and often times it comes along with shame or embarrassment. Let’s talk a little bit about what ED is and how physical therapy can help.

What is ED?

ED is the inability to develop and/or maintain a penile erection for satisfactory sexual intercourse. ED does not constitute an ejaculatory disorder, which is a distinct and separate condition. The prevalence of ED is not entirely understood, with some studies estimating that it affects 3-76% of males, but most studies report that ED affects one third of all men (1). The prevalence of ED increases with age, meaning that older folks are more likely to be affected by the condition (2). While this is a super common condition, many men fail to seek treatment for the condition. One study reported that 70-80% of men were hesitant to seek treatment due to embarrassment or shame relating to the condition (3).

What causes ED?

To understand ED, we first have to understand what causes penile erection. Penile erection is the physiological process in which the penis becomes engorged with blood. This is often a response to sexual arousal. In order for a penis to become erect, there must be increased flow of blood to the penis and decreased blood flow out of the penile tissues. Arteries bring blood to the penis and veins drain blood out of the penis. In cases where arteries are blocked narrowed, ED can occur because not enough blood can flow to the penis. Aside from this hemodynamic process, penile erection is also made possible by certain nerves. These include the pudendal and cavernosus nerves. The pudendal nerve is responsible for penile sensation and innervation of the superficial pelvic floor muscles (PFMs). These superficial PFMs include the ischiocavernosus and bulbospongiosus muscles. They work to maintain erection by contracting and compressing the veins of the penis. This decreases the amount of blood that is drained out of the penis and helps it to remain engorged.

Since penile erection relies on the presence of blood to occur, a lack of good blood flow can result in ED. Therefore, poor cardiovascular function and cardiovascular disease are risk factors for ED (1). Another common cause for ED is radical prostatectomy surgery. After such surgery, rates of ED soar up to 85% (4). Radical prostatectomy is usually performed in folks with prostate cancer where the cancer is confined within the prostate gland. During this procedure, the cavernosus nerves, are disrupted and may take up to 24 months to heal after the procedure (4). This may result in ED during the recovery period, or even longer. There are lots of other causes of ED, but these are some of the most common.

Can ED be treated in pelvic health physical therapy?

ED can be treated in pelvic health physical therapy and, in-fact, pelvic floor muscle (PFM) exercises are considered a first-line approach to the treatment of ED in folks looking for long-term resolution of symptoms (5). PFM exercises have been shown to be more effective at improving ED than Viagra and pelvic health physical therapy has been shown to improve erectile function back to normal in 40% of patients. Pelvic health physical therapy focuses on strengthening the PFMs and educating patients on lifestyle factors that could be contributing to their ED. It may also incorporate biofeedback, electric stimulation, and more.  

What are some other treatments for ED?

Let’s be honest here: male issues are studied far more often than female issues. Because of this, there are bum-loads of treatments for ED. I’m sure you’ve heard about Viagra, a pharmaceutical option for improving the symptoms of ED. There are also vacuum erection devices. These devices create a vacuum around the penis and help to engorge the penile tissue to create an erection. Another potential treatment for ED is penile prosthesis (5). These devices come in inflatable and non-inflatable forms. Physical activity can also reduce the severity of ED (6). Since physical activity directly impacts blood flow and blood vessel health, it is the lifestyle factor most strongly correlated with ED. Regular moderate-to-vigorous physical activity can reduce or prevent ED (7). All of the above-mentioned treatments for ED are associated with high levels of patient satisfaction and improvements to quality of life.  

ED is an issue affecting men all over the world. While it is nothing to be ashamed about, it can be emotionally damaging to folks suffering from the condition. Suffering from ED can cause men to feel as if they have “lost their manhood.” If you’re suffering from ED, know that you have abundant treatment options and you deserve to be treated by a healthcare professional that delivers specific and non-judgmental care. Whether you choose to seek treatment or not, your ED doesn’t define you or your gender.

XOXO,

Your Pelvic Bestie

References:

1. Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med. 2018 Jun;6(2):75-89. doi: 10.1016/j.esxm.2018.02.001. Epub 2018 Apr 13.

2. Prins J., Blanker M.H., Bohnen A.M. Prevalence of erectile dysfunction: a systematic review of population-based studies. Int J Impot Res. 2002;146:422–432.

3. Gerster S, Gunzler C, Roesler C, Leiber C, Berner M. Treatment motivation of men with ED: what motivates men with ED to seek professional help and how can women support their partners? Int J Impotence Res. 2012;25:56-‐‐62.

4. Emanu J.C., Avildsen I.K., Nelson C.J. Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions. Curr. Opin. Support. Palliat. Care. Mar 2016;10(1):102–107.

5. Segal R, Burnett A. Erectile preservation following radical prostatectomy. Ther Adv Urol. 2011;3:35-‐‐46.

6. Hannan J.L., Maio M.T., Komolova M. Beneficial impact of exercise and obesity interventions on erectile function and its risk factors. J Sex Med. 2009;6(Suppl 3):254–261.

7. Maiorino M.I., Bellastella G., Esposito K. Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl. 2015;171:5–10.

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.