How Physical Therapy Can Help You Beat Erectile Dysfunction


Erectile dysfunction (ED) is most often associated with aging, particularly among men who also have other medical conditions like heart disease, type II diabetes and other metabolic disorders. However, ED can affect men of any age, seriously impacting your libido and quality of life, and that of your partner.

For healthy younger men, ED carries with it stigmatizing social and psychological ramifications that can undermine your confidence and self-esteem. However, in the absence of other serious health issues, there is a growing body of evidence to suggest that ED may be caused by dysfunction of the muscles of the pelvic floor, which can be treated with physical therapy.

Understanding how an erection occurs can lend insight into the role of your pelvic musculature in affecting erectile performance.

Anatomy of an Erection

Running the length of your penis from the head to deep inside your pelvis are two chambers called the corpora cavernosa. The chambers contain spongy tissues that, when infused with blood, become engorged, making your penis grow and harden.

Throughout most of the day, as you work, relax or exercise, the arteries that supply blood to your penis are constricted, allowing only enough blood in to feed and oxygenate your tissues. However, physical or mental arousal triggers a hormonal response from your brain that causes the arteries to fully dilate. Blood floods into the corpora cavernosa faster than it can exit via the veins, and the veins become compressed, trapping the blood in your penis and allowing you to sustain an erection.

Once the arousal stimulus stops, your brain no longer elicits a hormonal response, your arteries constrict, and blood exits via the veins, causing your penis to return to a flaccid state.

What Causes Erectile Dysfunction?

For most healthy younger men, erections come and go with little to no effort. However, in a small percent of cases, something goes wrong to interfere with the process of obtaining and sustaining an erection.

Some common causes of ED in healthy younger men include:

  • Performance anxiety
  • Relationship stress
  • Obesity
  • Poor nutrition
  • Lack of physical exercise
  • Poor sleep habits
  • Smoking
  • Drinking alcohol
  • Weakened or excessively tight pelvic floor muscles

Your Pelvic Floor and ED

During an erection and orgasm, your deep and superficial pelvic floor muscles play an active role in sustaining your erection and facilitating ejaculation. However, in some cases, the pelvic floor muscles can become either weakened (hypotonic) or tense (hypertonic), and either condition can affect your ability to achieve and sustain an erection.

Weakened pelvic floor muscles can result from lack of physical activity, making it difficult to sustain an erection and achieve ejaculation. Fortunately, the pelvic floor muscles can be strengthened fairly quickly with targeted exercises. Adopting a physically active lifestyle with balanced nutrition can further help promote sexual reproductive health.

Hypertonic, or tense pelvic floor muscles can result from nerve damage or prostate problems. Too-tight pelvic floor muscles can restrict blood flow to your penis, interfering with your ability to achieve and sustain an erection. Learning to relax the muscles of your pelvic floor may be the solution to your ED if the muscles are hypertonic.

Physiotherapy for Erectile Dysfunction

Like any other muscle in your body, the muscles of your pelvic floor can be trained. Whether you need to strengthen the muscles or learn to relax them, erectile dysfunction physical therapy can help.

It all begins with a detailed assessment and examination to determine whether your pelvic muscles are too weak or too tense. Targeted strengthening exercises will be prescribed if your muscles are hypotonic, and relaxation techniques will be used to address a hypertonic pelvic floor.

While ED can stem from a number of sources, your pelvic floor muscles play an active role in helping you achieve and sustain an erection. Physical therapy exercises to strengthen or relax the pelvic floor can positively impact your overall reproductive health, and in many cases, retraining the pelvic muscles is key to overcoming erectile dysfunction.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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