Erectile Dysfunction and Physiotherapy

Erectile dysfunction is a deeply personal and distressing problem that describes a condition where an erection is either not possible or is not sufficient for the desired task of sexual activity.  It is a condition that can have multiple causes and therefore you must discuss it with the GP if it is the 1st time you experience it. 

 

The GP will look for possible medical reasons for this problem and advise you accordingly or conduct tests where necessary.  We know that smoking, alcohol, a poor diet, diabetes, pelvic surgery, prostate cancer and prostatecomy, and lack of exercise can have an impact (for some) on erectile function.  We also know that stress can have a negative impact on erections.  Poor blood flow to the peipheraries can also affect erectile funciton and can be the result of chronic disease, and where this is the case, smoking and poor lifestyle habits must be halted.  Having a functional and strong pelvic floor is essential and this is where a specialist male pelvic Physiotherapist can help .  We can also advise on exercise, diet and general wellbeing to ensure it recovers and stays better.   

The Erection

When we become aroused, messages from the brain signal to the penile muscles (Corpus Carvernosa) to relax.  This allows blood to enter the eretile tissue of the Corpus Carvenosa and essesentially inflates the penis.  The blood infiltrates the spaces and tissue to achieve an erect state. The Tunica Albugenia the helps to trap the blood in the penis and keep it erect in an erect state.

The erectile tissue (Corpus Carvenosa and Crpus spongiosum) are extensions from the pelvic muscles of the Bulbospongiosus and Ischiocarvenosus.  It must be noted that these are different.  The penile muscles are smooth and therefore not under conscious control.  The latter two muscles are skeletal muscle and therefore more easily controlled. Therefore, it must be remembered that erectile states are complex and have multiple interactions.  

Blood flow is very complex with the main branches coming off the pudendal artery.  This passes throught he pelvic muscleature and therefore has ample opportunity to be impeded and influenced by pelvic muscle activity. 

 

 

Causes

  • Problems affecting the flow of blood to your penis
  • Conditions of the nervous system, which is made up of your brain, nerves and spinal cord
  • Changes or disease causing change in hormone levels
  • Physical structure problems in the penis 
  • Diabetes
  • Smoking
  • Psychological and emotional wellbeing
  • Intra-pelvic pain syndromes like Chronic Pelvic pain 
  • Post surgical injury to nerves and muscular tissue (Prostatectomy / TURPS) 
  • Cycling 

We could always recommend you see your GP 1st to rule out any other co-morbid factors. 

Treatment

Physiotherapy can help by:

  • Removal of aggravating factors
  • Consideration of life style: Alcohol, smoking, diet, exercise.
  • Manual therapy treatment to your low back and pelvis, getting the joints moving correctly
  • Trigger point therapy: Getting the muscles working properly and reduction of the overactive parts in the low back muscles, hip muscles and pelvic floor muscles. You will also be taught how to do this yourself.
  • Pelvic floor exercises to release your pelvic floor
  • Self stimulation activities are essential.  Using hot, cold, light and harder touching of the penis can help with sensory reactivation. If the nerves are damaged after surgery then sensory reception will be compromised.  Such activity can be done at home and often is better to do regularly.   
  • Specific hip, spine and pelvis exercises to get you and your pelvic floor moving better.
  • Specialised Breathing and relaxation work.  Relaxation through breathing has been found to be hugely beneficial for all types of conditions. 
  • Re-education of the  pelvic floor, hip and abdominal musculature
  • General exercise

We often recommend involving your partner as this will help with marital or relationship problems and in some cases can greatly expedite your recovery.  In some cases we will suggest you see a counsellor as this can be hugely beneficial.  Our minds and body are connected and we know about the harms that stress and anxiety can bring.  If there is tension in the pelvis then stress and anxiety can exacerbate already vulnerable and sensitised regions of the body. 

Shockwave can also be used to treat vascular erectile dysfunction and is fast becoming a popular solution for this condition.