Effects of Manual Therapy and Pelvic Floor Training on Erectile Dysfunction: A Case Series
Abstract
Introduction: Erectile dysfunction (ED) is a common issue in men, often associated with factors like obesity, diabetes, and more. This case series examines the impact of friction massage combined with pelvic floor exercises on ED in three patients, linked to prostatic adenectomy, aging, and diabetes.
Cases description: Patients followed a one-month regimen of pelvic floor exercises and techniques. The technique's progress was monitored via video calls twice a week. Exercises lasted for 10 minutes daily, along with a 10-minute massage. We assessed improvement using the International Index of Erectile Function 15 (IIEF15) questionnaire and EHS (Erection Hardness Score), as well as ultrasound scans. Following treatment, all three patients showed increased EHS and IIEF15 scores. Muscular thickness increased in the ischiocavernosus and bulbospongiosus muscles, while the cavernosal artery exhibited higher systolic velocity and lower diastolic velocity, although maximum blood flow velocity in the posterior vein decreased. Treatment had the most significant impact on the Adenectomy patient, followed by the elderly patient and then the diabetic patient. Combining friction massage and pelvic floor exercises led to improved erection-related indicators and increased patient satisfaction.
1 Consensus N. Development panel on impotence. NIH consensus conference. Impotence. Jama. 1993;270:83-90.
2. Najimi A, Veisani Y, Azami S, Azadi A. Investigating the sexual quality of life and its relationship with general health in older men in Iran. Journal of education and health promotion. 2020;9:150.
3. Al Demour S, Jafar H, Adwan S, AlSharif A, Alhawari H, Alrabadi A, et al. Safety and potential therapeutic effect of two intracavernous autologous bone marrow derived mesenchymal stem cells injections in diabetic patients with erectile dysfunction: an open label phase I clinical trial. Urologia internationalis. 2018;101(3):358-65.
4. Heaton J, Lording D, Liu S, Litonjua A, Guangwei L, Kim S, et al. Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. International journal of impotence research. 2001;13(6):317-21.
5. Talib R, Alnadhari I, Canguven O, Yassin A, Shamsodini A, Alrumaihi K, et al. HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction. Andrologia. 2021:e14132.
6. Taniguchi H, Imai K, Taniguchi S, Kitakoji H. Acupuncture in the treatment of erectile dysfunction among a diabetic population of sildenafil citrate non-respnder. Japanese Acupuncture and moxibustion. 2014;10(1):14-7.
7. Prota C, Gomes C, Ribeiro L, De Bessa J, Nakano E, Dall'Oglio M, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. International journal of impotence research. 2012;24(5):174-8.
8. Shendy WS, El Semary MM, Battecha KH, Abdel-Azim MS, Mourad HS, El Gohary AM. Efficacy of transcutaneous electrical nerve stimulation versus biofeedback training on bladder and erectile dysfunction in patients with spinal cord injury. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2015;52(3):194.
9. Fojecki GL, Tiessen S, Osther PJ. Effect of low-energy linear shockwave therapy on erectile dysfunction—a double-blinded, sham-controlled, randomized clinical trial. The journal of sexual medicine. 2017;14(1):106-12.
10. Dorey G, Speakman MJ, Feneley RC, Swinkels A, Dunn CD. Pelvic floor exercises for erectile dysfunction. BJU international. 2005;96(4):595-7.
11. Bailes BK. Diabetes mellitus and its chronic complications. AORN journal. 2002;76(2):266-76, 78-82; quiz 83-6.
12. Tripathi BK, Srivastava AK. Diabetes mellitus: complications and therapeutics. Medical science monitor : international medical journal of experimental and clinical research. 2006;12(7):Ra130-47.
13. Zhou W, Zhang Y, Li L, Gao J, Zheng H, Huang M, et al. Evaluation of Arterial Erectile Dysfunction Using Shear Wave Elastography: A Feasibility Study. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2021;40(6):1209-16.
14. Mirzoev TM. Skeletal Muscle Recovery from Disuse Atrophy: Protein Turnover Signaling and Strategies for Accelerating Muscle Regrowth. International journal of molecular sciences. 2020;21(21).
15. Geerkens MJM, Al-Itejawi HHM, Nieuwenhuijzen JA, Meuleman EJM, Lissenberg-Witte BI, van Moorselaar RJA, et al. Sexual Dysfunction and Bother Due to Erectile Dysfunction in the Healthy Elderly Male Population: Prevalence from a Systematic Review. European urology focus. 2020;6(4):776-90.
16. Mazur M, Zakrzewski W, Szymonowicz M, Rybak Z. Medical Adhesives and Their Role in Laparoscopic Surgery-A Review of Literature. Materials (Basel, Switzerland). 2022;15(15).
17. He K, Head J, Mouchtouris N, Hines K, Shea P, Schmidt R, et al. The Implications of Paraspinal Muscle Atrophy in Low Back Pain, Thoracolumbar Pathology, and Clinical Outcomes After Spine Surgery: A Review of the Literature. Global Spine J. 2020;10(5):657-66.
18. Bratu O, Oprea I, Marcu D, Spinu D, Niculae A, Geavlete B, et al. Erectile dysfunction post-radical prostatectomy - a challenge for both patient and physician. Journal of medicine and life. 2017;10(1):13-8.
19. Charles D, Hudgins T, MacNaughton J, Newman E, Tan J, Wigger M. A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. Journal of bodywork and movement therapies. 2019;23(3):539-46.
20. Davia J, Welty A. Manual therapy and education for physical therapy management of male chronic pelvic pain syndrome. Journal of Women’s Health Physical Therapy. 2014;38(1):3-10.
21 Dorey G, Speakman MJ, Feneley RC, Swinkels A, Dunn CD. Pelvic floor exercises for erectile dysfunction. BJU Int. 2005;96(4):595-7.
22. Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC, Hvidsten K. Outcomes assessment: validation of the erection hardness score. The journal of sexual medicine. 2007;4(6):1626-34.
23. Quek K, Low W, Razack A, Chua C, Loh C. Reliability and validity of the Malay version of the International Index of Erectile Function (IIEF-15) in the Malaysian population. International journal of impotence research. 2002;14(4):310-5.
24. MEHRABAN D, Shabaninia S, NADERI GH, Esfahani F. Farsi international index of erectile dysfunction and doppler ultrasonography in the evaluation of male impotence. 2006.
25. Lamacchia O, Sorrentino MR. Diabetes Mellitus, Arterial Stiffness and Cardiovascular Disease: Clinical Implications and the Influence of SGLT2i. Current vascular pharmacology. 2021;19(2):233-40.
26. Greenhalgh DG. Wound healing and diabetes mellitus. Clinics in plastic surgery. 2003;30(1):37-45.
27. Kizilay F, Gali HE, Serefoglu EC. Diabetes and Sexuality. Sexual medicine reviews. 2017;5(1):45-51.
28. Chang L, Zhao X, Garcia-Barrio M, Zhang J, Eugene Chen Y. MitoNEET in Perivascular Adipose Tissue Prevents Arterial Stiffness in Aging Mice. Cardiovascular drugs and therapy. 2018;32(5):531-9.
29. Hald GM, Graham C, Štulhofer A, Carvalheira A, Janssen E, Træen B. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. The journal of sexual medicine. 2019;16(8):1212-25.
30. Ginsberg TB. Aging and sexuality. The Medical clinics of North America. 2006;90(5):1025-36.
31. Adib F, Posner AD, O'Hara NN, O'Toole RV. Gluteal compartment syndrome: A systematic review and meta-analysis. Injury. 2022;53(3):1209-17.
32. Furr J, Hebert K, Wisenbaugh E, Gelman J. Complications of Genital Enlargement Surgery. The journal of sexual medicine. 2018;15(12):1811-7.
33. Kablan N, Can M, Ayvacı H, Gerçek N, Eroğlu ZA, Özgit B, et al. Biomechanical and Viscoelastic Properties of the Achilles Tendon and Plantar Fascia in Pregnant Women with Pelvic Girdle Pain: A Case-Control Study. Women & health. 2022;62(6):476-87.
34. Nogueira W, Gentil P, Mello SN, Oliveira RJ, Bezerra AJ, Bottaro M. Effects of power training on muscle thickness of older men. International journal of sports medicine. 2009;30(3):200-4.
2. Najimi A, Veisani Y, Azami S, Azadi A. Investigating the sexual quality of life and its relationship with general health in older men in Iran. Journal of education and health promotion. 2020;9:150.
3. Al Demour S, Jafar H, Adwan S, AlSharif A, Alhawari H, Alrabadi A, et al. Safety and potential therapeutic effect of two intracavernous autologous bone marrow derived mesenchymal stem cells injections in diabetic patients with erectile dysfunction: an open label phase I clinical trial. Urologia internationalis. 2018;101(3):358-65.
4. Heaton J, Lording D, Liu S, Litonjua A, Guangwei L, Kim S, et al. Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. International journal of impotence research. 2001;13(6):317-21.
5. Talib R, Alnadhari I, Canguven O, Yassin A, Shamsodini A, Alrumaihi K, et al. HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction. Andrologia. 2021:e14132.
6. Taniguchi H, Imai K, Taniguchi S, Kitakoji H. Acupuncture in the treatment of erectile dysfunction among a diabetic population of sildenafil citrate non-respnder. Japanese Acupuncture and moxibustion. 2014;10(1):14-7.
7. Prota C, Gomes C, Ribeiro L, De Bessa J, Nakano E, Dall'Oglio M, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. International journal of impotence research. 2012;24(5):174-8.
8. Shendy WS, El Semary MM, Battecha KH, Abdel-Azim MS, Mourad HS, El Gohary AM. Efficacy of transcutaneous electrical nerve stimulation versus biofeedback training on bladder and erectile dysfunction in patients with spinal cord injury. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2015;52(3):194.
9. Fojecki GL, Tiessen S, Osther PJ. Effect of low-energy linear shockwave therapy on erectile dysfunction—a double-blinded, sham-controlled, randomized clinical trial. The journal of sexual medicine. 2017;14(1):106-12.
10. Dorey G, Speakman MJ, Feneley RC, Swinkels A, Dunn CD. Pelvic floor exercises for erectile dysfunction. BJU international. 2005;96(4):595-7.
11. Bailes BK. Diabetes mellitus and its chronic complications. AORN journal. 2002;76(2):266-76, 78-82; quiz 83-6.
12. Tripathi BK, Srivastava AK. Diabetes mellitus: complications and therapeutics. Medical science monitor : international medical journal of experimental and clinical research. 2006;12(7):Ra130-47.
13. Zhou W, Zhang Y, Li L, Gao J, Zheng H, Huang M, et al. Evaluation of Arterial Erectile Dysfunction Using Shear Wave Elastography: A Feasibility Study. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2021;40(6):1209-16.
14. Mirzoev TM. Skeletal Muscle Recovery from Disuse Atrophy: Protein Turnover Signaling and Strategies for Accelerating Muscle Regrowth. International journal of molecular sciences. 2020;21(21).
15. Geerkens MJM, Al-Itejawi HHM, Nieuwenhuijzen JA, Meuleman EJM, Lissenberg-Witte BI, van Moorselaar RJA, et al. Sexual Dysfunction and Bother Due to Erectile Dysfunction in the Healthy Elderly Male Population: Prevalence from a Systematic Review. European urology focus. 2020;6(4):776-90.
16. Mazur M, Zakrzewski W, Szymonowicz M, Rybak Z. Medical Adhesives and Their Role in Laparoscopic Surgery-A Review of Literature. Materials (Basel, Switzerland). 2022;15(15).
17. He K, Head J, Mouchtouris N, Hines K, Shea P, Schmidt R, et al. The Implications of Paraspinal Muscle Atrophy in Low Back Pain, Thoracolumbar Pathology, and Clinical Outcomes After Spine Surgery: A Review of the Literature. Global Spine J. 2020;10(5):657-66.
18. Bratu O, Oprea I, Marcu D, Spinu D, Niculae A, Geavlete B, et al. Erectile dysfunction post-radical prostatectomy - a challenge for both patient and physician. Journal of medicine and life. 2017;10(1):13-8.
19. Charles D, Hudgins T, MacNaughton J, Newman E, Tan J, Wigger M. A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. Journal of bodywork and movement therapies. 2019;23(3):539-46.
20. Davia J, Welty A. Manual therapy and education for physical therapy management of male chronic pelvic pain syndrome. Journal of Women’s Health Physical Therapy. 2014;38(1):3-10.
21 Dorey G, Speakman MJ, Feneley RC, Swinkels A, Dunn CD. Pelvic floor exercises for erectile dysfunction. BJU Int. 2005;96(4):595-7.
22. Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC, Hvidsten K. Outcomes assessment: validation of the erection hardness score. The journal of sexual medicine. 2007;4(6):1626-34.
23. Quek K, Low W, Razack A, Chua C, Loh C. Reliability and validity of the Malay version of the International Index of Erectile Function (IIEF-15) in the Malaysian population. International journal of impotence research. 2002;14(4):310-5.
24. MEHRABAN D, Shabaninia S, NADERI GH, Esfahani F. Farsi international index of erectile dysfunction and doppler ultrasonography in the evaluation of male impotence. 2006.
25. Lamacchia O, Sorrentino MR. Diabetes Mellitus, Arterial Stiffness and Cardiovascular Disease: Clinical Implications and the Influence of SGLT2i. Current vascular pharmacology. 2021;19(2):233-40.
26. Greenhalgh DG. Wound healing and diabetes mellitus. Clinics in plastic surgery. 2003;30(1):37-45.
27. Kizilay F, Gali HE, Serefoglu EC. Diabetes and Sexuality. Sexual medicine reviews. 2017;5(1):45-51.
28. Chang L, Zhao X, Garcia-Barrio M, Zhang J, Eugene Chen Y. MitoNEET in Perivascular Adipose Tissue Prevents Arterial Stiffness in Aging Mice. Cardiovascular drugs and therapy. 2018;32(5):531-9.
29. Hald GM, Graham C, Štulhofer A, Carvalheira A, Janssen E, Træen B. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. The journal of sexual medicine. 2019;16(8):1212-25.
30. Ginsberg TB. Aging and sexuality. The Medical clinics of North America. 2006;90(5):1025-36.
31. Adib F, Posner AD, O'Hara NN, O'Toole RV. Gluteal compartment syndrome: A systematic review and meta-analysis. Injury. 2022;53(3):1209-17.
32. Furr J, Hebert K, Wisenbaugh E, Gelman J. Complications of Genital Enlargement Surgery. The journal of sexual medicine. 2018;15(12):1811-7.
33. Kablan N, Can M, Ayvacı H, Gerçek N, Eroğlu ZA, Özgit B, et al. Biomechanical and Viscoelastic Properties of the Achilles Tendon and Plantar Fascia in Pregnant Women with Pelvic Girdle Pain: A Case-Control Study. Women & health. 2022;62(6):476-87.
34. Nogueira W, Gentil P, Mello SN, Oliveira RJ, Bezerra AJ, Bottaro M. Effects of power training on muscle thickness of older men. International journal of sports medicine. 2009;30(3):200-4.
| Issue | Articles in Press | |
| Section | Case Report(s) | |
| Keywords | ||
| Erectile dysfunction, Prostatic Adenectomy, Aging, Type 2 diabetes, Friction massage, Pelvic floor muscle exercises | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Afshar Safavi M, Niknam H, Okhovatian F, Roostayi MM. Effects of Manual Therapy and Pelvic Floor Training on Erectile Dysfunction: A Case Series. jmr. 2024;(-):pdf.
