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Erectile Dysfunction

Explanation of common symptoms/ problems

Erectile dysfunction (ED) can occur at any age and can severely impact on the quality of life of men and their partners. 

It is estimated that ED occurs in 10% of healthy men without any apparent physical cause. This is known as idiopathic ED.

The reasons for  ED are often complex. They may include issues with:

  • the blood supply to the penis,
  • hormonal abnormalities,
  • interruption of normal nerve supply,
  • certain medications, 
  • psychogenic factors
  • weak or tight pelvic floor muscles.

Men with diabetes, high blood pressure, heart disease are at greater risk. ED also increases with age and may develop in men with an enlarged prostate and/or urinary incontinence. Sometimes it can develop following pelvic surgery, pelvic radiotherapy, pelvic trauma or spinal cord injury.

Lifestyle factors such as:

  • smoking,
  • high consumption of alcohol,
  • high cholesterol levels,
  • drug abuse,
  • cycling,
  • a sedentary lifestyle,
  • obesity
  •  weak pelvic floor muscles

It may come as no surprise that many men are embarrassed to come forward for treatment and may also suffer from low self-esteem and depression and experience difficulties in establishing and maintaining a relationship.

Treatment for ED includes lifestyle advice, medications (such as Viagra and Cialis), injections, pellets that are placed in the urethra, vacuum devices, hormone replacement therapy, psychological/talking therapies, surgical pumps and/or specialist pelvic floor physiotherapy.


Self help / Advice

There are lifestyle changes that you can make to help with ED including pelvic floor muscle exercises that are evidenced to help in idiopathic ED.

  • Getting started with pelvic floor exercises
  • Regular exercises will help strengthen your pelvic floor muscles, particularly the small pelvic floor muscles called the bulbocavernosus and the ischiocavernosus. The bulbocavernosus wraps around the base of the penis, assisting in keeping blood in the penis whilst it is erect. The ischiocavernosus muscles are thought to act like guy ropes and assist in supporting the erect penis.
  • You can make a start on exercises using our online instructions:
  • POGP pelvic floor exercises for men
  • To help with your exercises try the ‘Squeezy for Men’ app available on your  mobile phone app store
  • If you cycle regularly try the following:
    • adjust your saddle by tipping the front down slightly to take pressure off your perineum (the area between your back passage and your penis)
    • Lift yourself out of the saddle regularly (but only when safe to do so, to take pressure off your
  •  perineum

  • Consider buying a special saddle that reduces perineal pressure
  • If you are overweight, consider reducing it    
  • If you do not take regular exercise, consider getting fitter
  • Talking to a counsellor is often useful.  Your GP or physiotherapist can recommend a specialist psychosexual counsellor or in many regions you can self-refer for talking therapy If you are a smoker, consider smoking cessation
  • If you drink alcohol regularly, consider reducing the number of units you have per week or you may feel you need support to help you reduce your input:
  • If you use recreational drugs, consider reducing these


Where to go to next

  • Speak to your GP who may wish to refer you for investigations
  • You can also ask your GP if there is a specialist Men’s Health physiotherapy service that he/she can refer you to. If this isn’t available in your area or there is a long waiting list and you would like to find a specialist private physiotherapist, use the link below:

Find a Physiotherapist


What to expect from physiotherapy

How can a specialist Men’s Health physiotherapist help ED?

  • A specialist men’s health physiotherapist can help you to strengthen your pelvic floor muscles, particularly the small pelvic floor muscles called the bulbocavernosus and the ischiocavernosus.
  • If your pelvic floor muscles are tight, treatment will targeted at down training them.
  • The physiotherapist will advise on lifestyle changes and support you in gradually adopting these new strategies.
  • Your physiotherapist will discuss whether or not you feel there is a psychological component to your ED and will be able to sign post you to psychological help/talking therapy if you agree that this would be useful/ appropriate.
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