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  • Writer's pictureCarly Gossard

Erectile Dysfunction and Pelvic Floor Physical Therapy

Updated: Sep 24, 2022

Who hasn’t seen a commercial for “the little blue pill”? It is ICONIC... it typically portrays an older couple who is, shall we say, exceedingly happy after having taken Viagra. Erectile Dysfunction (ED) is more common than you think; According to The University of Wisconsin Health, ED affects 10% of men per decade which means 50% of men in their 50’s will experience ED… that is a staggering statistic! That means about 20% of males in their 20’s suffer from ED! How is this possible? Young men in their prime years! Cardiovascular health and pelvic floor function play a huge role in arousal, erection and ejaculation. If pelvic floor muscle dysfunction can contribute to erectile dysfunction… Pelvic floor physical therapy can help!

Considering Valentine’s Day is around the corner - we want to make sure everyone is well informed and sexual organs are running on all cylinders. Here are the top reasons why you or your partner may be experiencing ED:

1. Too much tone or tension in the pelvic floor muscles

When we think of muscle tone we often think of that being a good thing: shapely biceps, six-packs, strong glutes. Too much tone, however, can lead to trigger points and pain. Just like we often hold tension in our shoulders or jaw, we can hold tension in our pelvic floor. Many of the same pelvic floor muscles present in women are present in men. Most notably are the superficial pelvic floor muscles including the bulbospongiosus and ischiocavernosus (see below). In women, these muscles raise the clitoral hood and aid in stimulation and arousal. In men, these muscles play a large role in supporting the base of the penis during arousal and erection (they keep the soldier at attention). When muscles have trigger points or have too much tone, they can become weak as a result. The same goes for these pelvic floor muscles. For successful erection and ejaculation, pelvic floor muscles have to be able to relax AND contract! A skilled pelvic PT can address muscle trigger points, weakness or altered coordination.

2. Cardiovascular health

An erection occurs when the chambers of the penis fill with blood. If you or your partner has diabetes, high blood pressure or high cholesterol, this can affect blood flow to the penis! Often, erectile dysfunction can be one of the first red flags to cardiovascular disease. Good cardiovascular health and “getting the blood pumping” is crucial in increasing penile health and opening those blood vessels to better serve your soldier.

3. Masturbating

Frequent masturbation can be affecting your erection! Sex is better with a partner, but there’s a deeper reason why: during penetrative intercourse, the circumferential tension from a vagina or rectum is far less than from the vice grip during masturbation. When we talk about fascia, we are describing the spider web-like consistency that runs superficially and connects the entire body. Often, the fascia on the finger side of the grip tightens and the penis often starts to favor that side. (Right hand masturbators may have a penis bent towards the left and a Left hand masturbator may have a penis bent to the right). A tight grip could also be damaging the vasculature of the penis. Just like anywhere else in the body, fascia and tissue need to move and glide! Frequent vigorous rubdowns are often the cause of ED, especially in young men in their 20's and 30's.

4. Foods high in Nitric Oxide

Oxidation is the process that turns steel into rust. This same process occurs in your cells due to “free radicals”. Over time, “free radicals'' change the smooth muscle in your body to collagen, and the blood vessels become more stiff and narrow. Habits that increase free radicals include smoking, environmental toxins and a sedentary lifestyle. The body has antioxidants as a defense mechanism; one of those antioxidants being Nitric Oxide (NO). Viagra works by blocking phosphodiesterase to allow more NO to build up in the body. More NO means more smooth muscle relaxation and more blood flow to the penis. Voila! An erection! With medication, however, comes side effects such as headache, indigestion, palpitations, flushing and altered vision. If Viagra blocks phosphodiesterase too long, this can, for lack of a better word, suffocate the penis and damage the arterial system. This is why they say "call your doctor if you experience an erection lasting longer than four hours". Good nutrition and exercise are key in sustaining youthful cellular balance. Foods high in nitrates include fresh, unprocessed fruits, vegetables, legumes, nuts and grains.

One of my favorite resources for men’s pelvic and penile health is “The Penis Book” by Aaron Spitz, MD. Check it out!

Bottom line for healthy, happy boners: healthy hearts and bodies! This means regular exercise, annual checkups and bloodwork, leafy greens and foods high in nitric oxide and going easy on the self-play; your tube socks will thank you!

PSA: men have pelvic floors and can suffer from pelvic floor dysfunction (PFD). PFD in males can present as ED, urinary urge/frequency, pelvic pain, chronic constipation, abdominal, groin, hip or low back pain. If you are still experiencing erectile dysfunction, pelvic pain or trouble in the bedroom, a pelvic floor physical therapist can help!

Health & Happiness,

Dr. Carly & Dr. Katie


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