madman
Super Moderator
ABSTRACT
Introduction: Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. Objectives: To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED.
Methods: We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises.
Results: The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients’ clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training.
Conclusions: A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE.
*This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED.
INTRODUCTION
Sexual dysfunctions have been described as disturbances and psychophysiological changes associated with the sexual response cycle in men and women.1 Sexual dysfunctions are extremely prevalent in men, ranging from 10% to 52%, and are associated with demographic attributes such as age and educational attainment.1 Sexual function is believed to be an indispensable and integral part of men’s overall health and wellness. Moreover, male sexual dysfunctions have been found associated with a poor quality of life and negative interpersonal relationships.2
The most prevalent sexual impairments in men are erectile dysfunction (ED) and premature ejaculation (PE).3,4 Sexual impairment can be psychological, muscular, neurological vascular, or a combination of all. Acceptable drug treatment for ED and PE can be accompanied by adverse effects, that is, headache, flushing, indigestion, and rhinitis. Moreover, visual adverse disturbances include temporary changes in color vision, increased sensitivity to light, and blurring of vision.5 In previous studies, male pelvic pain and dysfunction were observed in individuals suffering from PE, and ED.2,6 Pelvic floor muscles (PFMs) are important in improving sexual function. It has been reported that contractions/relaxation of the PFMs in males is associated with mechanisms of erection and ejaculation.7 It has been ascertained that male PFMs increase penile rigidity and hardness in those suffering from ED, potentially enabling vaginal penetration during thrusting.2 Therefore, one may assume that improving the PFM’s function, would enable an individual to improve his sexual performance and outcome. Our aim was to investigate the effect of physical therapy pelvic floor rehabilitation on men suffering from PE and ED.
RESULTS
*Anatomy and Physiology of Male’s PFMs
*Male Sexual Impairment
-Erectile Dysfunction (ED)
-Premature Ejaculation (PE)
*Pelvic Floor Evaluation and Assessment
*Physical Therapy Assessment for ED
*Physical Therapy Assessment for PE
*Physical Therapy Treatment for ED
*Physical Therapy Treatment for PE
CONCLUSIONS
Current evidence is encouraging, even though, further high-quality evidence is still necessary to attain a better understanding of the effectiveness of PFM training and the part that physical therapy plays in the management of PE and ED. Physical therapists choose a multifaceted approach when assessing and treating PFM dysfunction, focusing on musculoskeletal dysfunction and behavioral involvement. Although research studies have supported PFM training for improving PE,27,34,35 it is recommended that therapeutic exercises should be supervised to avoid situations such as hyperactivity/increased tone of the PFMs. Furthermore, soft tissue treatment is occasionally required as part of the complex treatment.
We believe that PFM training, due to its simplicity, safety, and noninvasiveness, should continue to be the preferred approach in the management of ED and PE. Less invasive tactics must always be contemplated before aggressive approaches that are more costly and have further side effects. If the patient does not benefit from conservative management, the options of medical and surgical therapy remain available. Patient education is a vital component of physical therapy intervention. The physical therapist's role is to ensure that the patient completely comprehends the physiological changes of the body during sexual desire and arousal. The physical therapist can instruct the patient as to additional possibilities for achieving desire and arousal, varying from exploring the senses or exposing the patient to other resource material that is films or literature.8
There is a need for high-quality clinical trials examining the long-term effectiveness of PFM training. Consideration should be given to the development of an optimal PFM training regimen, taking into account the various exercise positions, contraction intensity, contraction time, rest time, number of repetitions, number of sets performed daily, number of training days per week, and duration of the intervention.
*In conclusion, conservatively treating men suffering from PE and ED i.e., physical therapy, should be the first line of treatment and a possible solution for whom drug therapy is not possible. This review illustrated that treatment that includes guidance, tissue release, and reinforcements can improve PE and ED.
Introduction: Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. Objectives: To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED.
Methods: We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises.
Results: The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients’ clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training.
Conclusions: A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE.
*This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED.
INTRODUCTION
Sexual dysfunctions have been described as disturbances and psychophysiological changes associated with the sexual response cycle in men and women.1 Sexual dysfunctions are extremely prevalent in men, ranging from 10% to 52%, and are associated with demographic attributes such as age and educational attainment.1 Sexual function is believed to be an indispensable and integral part of men’s overall health and wellness. Moreover, male sexual dysfunctions have been found associated with a poor quality of life and negative interpersonal relationships.2
The most prevalent sexual impairments in men are erectile dysfunction (ED) and premature ejaculation (PE).3,4 Sexual impairment can be psychological, muscular, neurological vascular, or a combination of all. Acceptable drug treatment for ED and PE can be accompanied by adverse effects, that is, headache, flushing, indigestion, and rhinitis. Moreover, visual adverse disturbances include temporary changes in color vision, increased sensitivity to light, and blurring of vision.5 In previous studies, male pelvic pain and dysfunction were observed in individuals suffering from PE, and ED.2,6 Pelvic floor muscles (PFMs) are important in improving sexual function. It has been reported that contractions/relaxation of the PFMs in males is associated with mechanisms of erection and ejaculation.7 It has been ascertained that male PFMs increase penile rigidity and hardness in those suffering from ED, potentially enabling vaginal penetration during thrusting.2 Therefore, one may assume that improving the PFM’s function, would enable an individual to improve his sexual performance and outcome. Our aim was to investigate the effect of physical therapy pelvic floor rehabilitation on men suffering from PE and ED.
RESULTS
*Anatomy and Physiology of Male’s PFMs
*Male Sexual Impairment
-Erectile Dysfunction (ED)
-Premature Ejaculation (PE)
*Pelvic Floor Evaluation and Assessment
*Physical Therapy Assessment for ED
*Physical Therapy Assessment for PE
*Physical Therapy Treatment for ED
*Physical Therapy Treatment for PE
CONCLUSIONS
Current evidence is encouraging, even though, further high-quality evidence is still necessary to attain a better understanding of the effectiveness of PFM training and the part that physical therapy plays in the management of PE and ED. Physical therapists choose a multifaceted approach when assessing and treating PFM dysfunction, focusing on musculoskeletal dysfunction and behavioral involvement. Although research studies have supported PFM training for improving PE,27,34,35 it is recommended that therapeutic exercises should be supervised to avoid situations such as hyperactivity/increased tone of the PFMs. Furthermore, soft tissue treatment is occasionally required as part of the complex treatment.
We believe that PFM training, due to its simplicity, safety, and noninvasiveness, should continue to be the preferred approach in the management of ED and PE. Less invasive tactics must always be contemplated before aggressive approaches that are more costly and have further side effects. If the patient does not benefit from conservative management, the options of medical and surgical therapy remain available. Patient education is a vital component of physical therapy intervention. The physical therapist's role is to ensure that the patient completely comprehends the physiological changes of the body during sexual desire and arousal. The physical therapist can instruct the patient as to additional possibilities for achieving desire and arousal, varying from exploring the senses or exposing the patient to other resource material that is films or literature.8
There is a need for high-quality clinical trials examining the long-term effectiveness of PFM training. Consideration should be given to the development of an optimal PFM training regimen, taking into account the various exercise positions, contraction intensity, contraction time, rest time, number of repetitions, number of sets performed daily, number of training days per week, and duration of the intervention.
*In conclusion, conservatively treating men suffering from PE and ED i.e., physical therapy, should be the first line of treatment and a possible solution for whom drug therapy is not possible. This review illustrated that treatment that includes guidance, tissue release, and reinforcements can improve PE and ED.
