Men's health is an area of physiotherapy that is gaining momentum and the evidence base is expanding rapidly.
Physiotherapists have long been successful in helping women with functional disorders of the pelvic floor. Physiotherapy for men's health is slowly gaining momentum. As more research is done each year, we find that interventions that focus on the pelvic floor muscles can help with a variety of pelvic problems in men. Cohen et al., 2015, published a literature review introducing readers to the basic functional anatomy of a male pelvic floor, its relationship to sexual function, and how pelvic floor muscle rehabilitation can help.
The role of the male pelvic floor muscles in erectile function
An erection occurs due to a complex interaction between the vascular system, the parasympathetic, sympathetic, somatic and central nervous systems, with hormones and the muscular system also playing an important role. An erection occurs when blood flows into the corpus cavernosa (tubes in the penis) faster than it can leave the penis and a closed hydraulic system maintains the erection.
All pelvic floor muscles (superficial and deep) have proven to be active during an erection and an orgasm. The sciocavernosus helps maintain the rigidity of an erect penis, and rapid contraction of the bulbospongiosus muscles is important for ejaculation.
The role of the prostate in erectile dysfunction is often overlooked, especially the effects of prostate cancer surgery. Prostate cancer treatment options all have their pros and cons, but impaired sexual function is a common side effect regardless of treatment approach. This is due to the prostate's close relationship with the nerves, vascular structures, and muscles that control an erection, as well as other aspects of sexual function such as ejaculation and orgasm. Damage to these structures during surgery or from radiation therapy can lead to debilitating sexual dysfunction that can negatively affect a man's quality of life.
Sexual dysfunction after prostate cancer
Muscle dysfunction in erectile dysfunction
The pelvic floor muscles can become weaker or hypoactive or have a higher resting tone, which is known as hyperactive pelvic floor. Both can affect erectile function in different ways. The pelvic floor muscles can weaken with age and inactivity. They can also become hypoactive from nerve damage such as post prostatectomy. When underactive, they cannot help maintain an erection or allow ejaculation and orgasm. Pelvic floor muscles can become hyperactive in men with chronic prostatitis and chronic pelvic pain syndrome. This leads to a higher resting tone or a "tight" pelvic floor. It is believed that when the pelvic floor muscles have too high a resting tone, they can compress the lumen from the outside, restricting blood flow to the penis and thereby affecting the erection.
Retraining and exercise
There is increasing evidence that retraining of the pelvic floor muscles can be very effective in the treatment of erectile dysfunction. A detailed assessment by a suitably qualified physiotherapist will determine whether the pelvic floor muscles play a role. The most important part is to determine whether the pelvic floor is hypoactive or hyperactive . Exercising the pelvic floor will greatly improve erectile function in people with an underactive pelvic floor, but will make an overactive pelvic floor significantly worse. Men with overactive pelvic floor muscles need to work on exercising or relaxing their pelvic floor muscles rather than strengthening themselves.
Kegel's exercises are a good first step in learning about retraining and strengthening the pelvic floor.
How to make kegels
Find the right muscles:
To identify the pelvic floor muscles, stop urinating in the middle of the flow. These are pelvic floor muscles. When the pelvic floor muscles contract when you look in the mirror, the base of the penis moves closer to the abdomen and the testicles rise.
Squeeze the muscle ring around the anus as if trying to stop the wind passing by. Now relax that muscle. Squeeze and release a few times until you're sure you've found the right muscles. Try not to squeeze your buttocks.
Perfect the technique: once identified, empty the bladder and lie on your back with your knees bent and knees apart. Tense the pelvic floor muscles, hold the contraction for three seconds, and then relax for three seconds. Try it a couple of times in a row, but don't overdo it. When the muscles get stronger,
Progress: Try doing Kegel exercises while sitting, standing, or walking on a flat / dynamic surface.
Maintain Focus: For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your stomach, thighs, or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises. Repeat 3 times a day. Aim for at least three sets of 10 repetitions per day [4]. Increase the contraction time to 8-10 seconds.
Additional tips:
Fast contractions: After the slow contractions described above, perform 5-10 very fast contractions (squeezes). This can help prevent an accident by quickly stopping urine leaks
Remember to keep the abdominal, abdominal, and leg muscles relaxed during the Kegel exercises. Feel only the muscles between the legs (pelvic muscles), around the anus, that are contracting. Try not to hold your breath during these exercises
Clinical Lessons
While the ability to achieve and maintain an erection is multifactorial, the pelvic floor muscles play a crucial role. Exercising the pelvic floor muscles has been shown to be an effective therapy in the treatment of erectile dysfunction. You might even be the missing link for some men who are struggling and have tried other interventions.
This article was originally published in April 2019 and written by Mandy Roscher . The page has now been updated for freshness, accuracy and completeness.
References
Cohen D, Gonzalez J, Goldstein I. The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sex Medicine Reviews. 2016, January 1st; 4 (1): 53-62.
Rudolph E, Boffard C, Raath C. Physiotherapy of the pelvic floor for erectile dysfunction – fact or error ?. The diary of sexual medicine. 2017, June 1st; 14 (6): 765-6.
