Pelvic floor exercises should be considered as a first-line approach for men seeking long-term resolution of their erectile dysfunction

Sexual dysfunction usually results from more than one factor and several components, biological, psychological and relational can contribute to dysfunction. Among the multiple factors involved in sexual dysfunction, the pelvic floor appears to have an important influence.

The pelvic floor muscles are active during erection and work to enhance rigidity and allow ejaculation. Pelvic floor exercise has been reported in the treatment of premature ejaculation. Studies suggest that more than 60% of patient with premature ejaculation were better able to control this reflex after 15-20 sessions of pelvic floor rehabilitation.

Rehabilitation of the pelvic floor consists of exercise and possible use of intra-anal electrostimulation and biofeedback. Men who seek to change their lifestyle such as reducing alcohol consumption, stopping smoking, reducing weight, getting fit and avoiding bicycle saddle pressure show very little improvement in erectile function, however men treated with pelvic floor exercises in conjunction with these lifestyle changes are a much better result in treating their erectile dysfunction.

Following training with pelvic floor exercises for at least 3 months, men who improve report the return of an erection on waking before gaining an erection sufficient for vaginal intercourse. Sometimes men who have other co-morbidities such as cardiovascular disease, atherosclerosis, diabetes or those who consume excessive amounts of alcohol fail to improve with exercise. It is also evident that younger men improve more than their older counterparts and men taking antihypertensive medication improve less than those not on medication.