INVESTIGATIVE UROLOGY

Pelvic floor exercises for erectile dysfunction
Dorey G, Speakman MJ, Feneley RC, Swinkels A, Dunn CD
The Somerset Nuffield Hospital, Taunton, UK
BJU Int. 2005; 96: 595-7

• Objective: To examine the role of pelvic floor exercises as a way of restoring erectile function in men with erectile dysfunction.
• Patients and Methods: In all, 55 men aged > 20 years who had experienced erectile dysfunction for ³ 6 months were recruited for a randomized controlled study with a cross-over arm. The men were treated with either pelvic floor muscle exercises (taught by a physiotherapist) with biofeedback and lifestyle changes (intervention group) or they were advised on lifestyle changes only (control group). Control patients who did not respond after 3 months were treated with the intervention. All men were given home exercises for a further 3 months. Outcomes were measured using the International Index of Erectile Function (IIEF), anal pressure measurements and independent (blinded) assessments.
• Results: After 3 months, the erectile function of men in the intervention group was significantly better than in the control group (P < 0.001). Control patients who were given the intervention also significantly improved 3 months later (P < 0.001). After 6 months, blind assessment showed that 40% of men had regained normal erectile function, 35.5% improved but 24.5% failed to improve.
• Conclusion: This study suggests that pelvic floor exercises should be considered as a first-line approach for men seeking long-term resolution of their erectile dysfunction.
  
  
• Editorial Comment
  The first time that pelvic floor exercise was discussed and documented as a realistic alternative for treatment of erectile dysfunction was in 1993 by Claes & Baert, for patients with mild degrees of venous leakage (1). The authors randomized a group of 150 consecutive male patients with erectile dysfunction and proven venous leakage to surgery of to a program of pelvic floor training. Surgery was not superior to the pelvic floor training program either subjectively or objectively. 42% of patients was satisfied with the program and refused surgery (1). Since then, a couple of works have been done on this subject, with somewhat good results (2,3).
  Doctor Grace Dorey and co-workers have been extensively working in this field, examining the role of pelvic floor muscle exercises (focusing on the bulbocavernosus and ischiocavernosus muscles) as a key to restoring erectile function. The present work is one more important contribution from this group. The authors concluded that pelvic floor muscle exercises should be considered as a first-line approach for erectile dysfunction. This might be more important in men seeking long-term resolution of erectile dysfunction without acute pharmacological and surgical interventions, which can cause significant side-effects.

References
1. Claes H, Baert L: Pelvic floor exercise versus surgery in the treatment of impotence. Br J Urol. 1993; 71: 52-7.
2. Ballard DJ: Treatment of erectile dysfunction: can pelvic muscle exercises improve sexual function?J Wound Ostomy Continence Nurs. 1997; 24: 255-64.
3. Van Kampen M, De Weerdt W, Claes H, Feys H, De Maeyer M, Van Poppel H: Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Phys Ther. 2003; 83: 536-43.

Dr. Francisco J.B. Sampaio
Full-Professor and Chair, Urogenital Research Unit
State University of Rio de Janeiro
Rio de Janeiro, Brazil