Prostatectomy and the Pelvic Floor Part 2

Erectile Dysfunction- try physical therapy first!

Erectile dysfunction is defined as the inability to get or maintain an erection that is firm enough for satisfying sexual activity. It can also refer to the inability to get or maintain an erection that is as rigid as it used to be (1). Erectile dysfunction is more common in older age groups, but can be diagnosed at any age. In younger individuals this can be a sign of a serious underlying condition including Benign Prostatic Hyperplasia (BPH) and prostate cancer. Erectile Dysfunction is also a common side effect after prostatectomy.
How does physical therapy help?

• Restore pelvic floor function. Whether you need to learn how to relax your muscles (because tight muscles are weak muscles) or you need to strengthen, a well trained pelvic physical therapist can pinpoint your greatest need and develop an individualized plan for you.
• Cardiovascular health. Another important aspect of both post-prostatectomy rehab and ED rehab includes improving your cardio fitness. Good cardiovascular fitness helps improve your overall health and wellness, improves energy and improves blood flow which is an important component of the erection process!
• Despite using sexual aids, only 30-62% of men remain sexually active or satisfied with their sexual functioning 1-5 years after radical prostatectomy​

If you tuned into our part one blog post, about prostatectomy and the pelvic floor,  I mentioned that the prostate is an important structure that adds rigidity to the pelvic system. The removal of part or all of the prostate increases the risk of both erectile dysfunction and urine leakage due to the loss of this support structure. Some other common changes after prostatectomy include minimal or no ejaculate (because the prostate and seminal vesicles, which produce semen and ejaculatory fluid have been removed or damaged by radiation or chemo). This also means that fertility will be affected and you will no longer be able to conceive children naturally (2). 
For anyone suffering from erectile dysfunction, whether after a prostatectomy or not, the research supports trying physical therapy first.  A couple of benefits of physical therapy:

• Fewer negative side effects than medication or surgery
• PT focuses on self directed improvements that you can maintain on your own, long term
• Minimally invasive- you are in charge of how in depth the examination and treatment are. There are some great external biofeedback techniques that mean we can visualize your pelvic floor function without having to get undressed!

Physical Therapy aids in erectile function by restoring function to the voluntary muscles of the pelvic floor. During normal arousal these muscles act automatically to close off the veins of the penis so that blood that has flowed in cannot escape (this is how the penis becomes rigid during erection). In typical erections these muscles act without you having to think about it, but they can also be trained purposely to perform these functions better. Another important aspect of both post-prostatectomy rehab and ED rehab includes improving your cardio fitness. Good cardiovascular fitness helps improve your overall health and wellness, improves energy and improves blood flow which is an important component of the erection process!

If you or someone you love is experiencing ED (related to a surgical procedure or not) give us a call today; our expertly trained, passionate physical therapists are available to answer your questions about your specific problem and to see if physical therapy is the right treatment for you. Or click the link below to request a free, no commitment 20 minute consultation to meet with Kristen, our male pelvic floor specialist. ​

1. Erectile Disorder | Psychology Today 
2. Prostate Cancer foundation patient guide
3. Prota et al. (2012) Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. Int J. Impot. Res. 24, 174-178
4. Sommer, F., Raible, A., Bondarenko, B., et al. A conservative treatment option of curing venous leakage in impotent men. Eur. Urol. 1 (Suppl. 1), 153
5. Matthew, A. et al, 2018- The Prostate Cancer Rehab Clinic: a biopsychosocial clinic for sexual dysfunction after radical prostatectomy