A Review of “The Role in Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain” Cohen, D., Gonzalez, J., & Goldstein, I. (2016).
Much of the research on male sexual dysfunction has previously been focused on neurological or vascular causes. More recently, studies have turned their focus to the involvement of the pelvic floor. The pelvic floor helps to stabilize the internal organs and gives bowel and bladder control. Research has shown that physical therapy intervention in treatment of the pelvic floor musculature is a safe and conservative method for treatment of male sexual dysfunction and pelvic pain. The causes of sexual dysfunction and pelvic pain that can be managed by physical therapy include erectile dysfunction, ejaculatory/orgasmic dysfunction, and chronic prostatitis/chronic pelvic pain syndrome.
Erectile Dysfunction
- Muscles involved: bulbospongiosus and ischiocavernosus
- Both of these muscles contribute to increased engorgement and expulsion of seminal fluid
- These muscles need strength and coordination in order to properly contribute to erection
- Pelvic floor exercise has been found to be effective in men with mild to moderate veno-occlusive dysfunction
- Literature has suggested that voluntary contraction of the ischiocavernosus can increase penile pressure, thus increasing penile hardness
- Erectile dysfunction may also occur from high resting tension in the pelvic floor muscles, in which case causing an inability for enough blood to enter the penis
- Literature has suggested that relaxation techniques of the pelvic floor muscles may resolve erectile dysfunction caused by high resting muscle tone
Ejaculatory/Orgasmic Dysfunction (Premature Ejaculation)
- Involuntary contraction of the bulbospongiosus muscle causes fluid expulsion
- Strengthening of this muscle has been suggested to increase ejaculatory volume and force, as well as increasing orgasmic pleasure
- Inhibition of the ejaculatory reflex may by possible through increased control over the perineal musculature
- One recommended method is to perform a sustained contraction of the pelvic floor during intercourse to quell ejaculation
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
- Patients with this condition have higher resting tension in the pelvic floor musculature than their unaffected peers
- Has also been found to cause tenderness in the psoas major and adductors
- This condition is commonly associated with erectile dysfunction
- Neuromuscular reeducation is recommended to facilitate relaxation of the pelvic floor muscles
- Recommendation for exercise: relaxation of the puborectalis and external anal sphincter combined with abdominal contraction & compression of the diaphragm
- Patients may also find relief of symptoms with soft tissue mobilization or myofascial release
- Repetitive contraction and relaxation of the pelvic floor musculature can help patients become more aware of how it feels to have the pelvic floor relaxed
Conclusion
Research has shown support for use of physical therapy treatment of the pelvic floor musculature as a safe and effective option for the aforementioned conditions of male sexual dysfunction. Physical therapy treatment of such conditions is still being researched, but will hopefully become a more well known option for patients seeking conservative treatment.
The following are exercises that can be done with patients to help them gain strength of the pelvic floor muscles: and are from www.medicalnewstoday.com, “Do Erectile Dysfunction Exercises Help?”
Knee Fallouts
- Have the patient lay supine with their knees bent, feet flat on the floor, and arms by their sides; instruct them to keep their back in a neutral position
- Have the patient contract their pelvic floor muscles while exhaling. Then have them slowly lower one knee out to the side, keeping the pelvic floor muscles contracted. The muscles or letting their pelvis lift off the floor.
- Next have the patient bring their knee back to where it started while inhaling and relaxing the pelvic floor muscles.
- Repeat with the other knee.
- Have the patient start with 4-5 reps on each side, working towards a goal of 10 reps per side.
Supine Foot Raises
- Have the patient lay supine with their knees bent, feet flat on the floor, and arms by their sides
- Instruct the patient to contract the pelvic floor muscles while exhaling, then lift one foot in the air and straightening their knee
- Next the patient will lower their foot back to the floor while inhaling and relaxing the pelvic floor muscles
- Repeat on the other side
- Start with 4-5 reps on each side, working towards 10 reps on each side
Pelvic Curl
- Patient lies supine with the knees bent, feet flat on the floor, and arms by their sides
- Make sure the patient keeps their spine in a neutral position
- Have the patient contract their pelvic floor muscles and exhale
- The patient next will push their back flat against the floor
- They will then slowly lift their buttocks off the floor while pushing their heels into the floor
- Patient contracts their buttocks as they lift it off the floor; they should lift until they are in a bridge position
- While keeping their buttocks in the air, have them take 3 breaths in and out and contract the buttock and pelvic floor muscles
- Next have the patient slowly lower their buttocks to the floor, rolling one vertebrae at a time.
- Start by doing 3-4 reps, and work towards doing 10 reps as the patient gets stronger
Shared by the Center for Victims of Torture, December 2019
Created by Samantha Wolcott, doctoral physiotherapy student at the University of Minnesota, USA