All information Professor Grace Dorey 2007

Men - Erectile dysfunction


Many men have difficulty gaining or maintaining erections and the prevalence increases with age. Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance for both partners. The severity of erectile dysfunction has been classified as mild, moderate or severe. Men who achieve satisfactory sexual performance 7 to 8 attempts out of 10 are classified as having mild erectile dysfunction, those who achieve 4 to 6 out of 10 are classified moderate, and those who achieve 0 to 3 out of 10 are classified severe.

The exact prevalence of erectile dysfunction is unknown. Erectile dysfunction affects more than 20% of men under 40 years of age, more than 50% of men over 40 years of age and more than 66% of men over 70 years of age.

Erectile dysfunction may be caused as a result of insufficient blood reaching the penis, weak pelvic floor muscles, inability of the muscles within the penis to relax, hormonal abnormalities, nerve involvement, and psychogenic factors. Some medication is related to erectile dysfunction. It may affect greater numbers of men with existing co-morbidities such as hypertension, heart disease and diabetes mellitus. Other risk factors include accidental trauma, trauma from surgery, and radiation therapy. Lifestyle-related factors include cigarette smoking, chronic obstructive lung disease, alcohol abuse, drug abuse, bicycling and horse riding. Erectile dysfunction always has a psychological component in addition to the underlying cause.

Pelvic floor exercises

Men can exercise their pelvic floor muscles to prevent erectile difficulties and restore normal erections. Research has shown that 40% of men who had experienced erectile difficulties for 6 months or more regained normal erections after performing pelvic floor exercises for 3 to 6 months. A further 35% of men improved their rigidity (Dorey et al 2004).

Pelvic floor muscle exercises are best taught individually by a therapist to ensure that they are being performed correctly. They can be described as ‘tightening and lifting the pelvic floor muscles as in the control of wind’. It is important that men lift up these muscles when exercising and avoid pushing down. During a correct contraction, you should see your testicles rise and your penis withdraw slightly into your body. Your penis will stay flaccid.

Maximum effort should be used when tightening the pelvic floor muscles in order to increase muscle strength and bulk. The quality of the contraction is more important than the quantity performed. Each contraction should be as strong as possible and held for the length of time specific to the individual but no longer than 10 seconds followed by a recovery phase of 10 seconds.

The pelvic floor muscles should be tightened before and during strenuous activities which increase intra-abdominal pressure such as coughing, sneezing, lifting, and rising from sitting.

In order to achieve full fitness and endurance, some longer lasting, less strong contractions should be performed. There should be an attempt to contract the pelvic floor muscles slightly whilst walking, to encourage the muscles to work over time with activity. Clinical trials have shown that people who are motivated, practise their exercises correctly and adhere to the advice given, have a more successful treatment outcome.

Professional help

A Specialist Continence Physiotherapist or a Continence Nurse Specialist can assess the problem for you, grade the strength of your pelvic floor muscles, give you the correct advice and start you on an exercise plan. Your GP will be able to give you the name of the best professional to help you.

Stronger and Longer! is a self-help book for men who have loss or partial loss of their erection and shows when and how to perform pelvic floor exercises to regain your erections. 

>> Click here

Use it or Lose it! is a self-help book specially for men with incontinence and erectile difficulties. It shows you how to perform pelvic floor exercises effectively and provides many helpful tips on how to prevent urinary leakage and regain erectile function.

>> Click here
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