The Role of Physiotherapy in Erectile Dysfunction

What Is Erectile Dysfunction?

Erectile dysfunction (ED) is defined as the inability of the penis to erect or hold on to the erection during sex until penetration or until satisfactory sex. Most men have this complaint, and it results in stress, marriages falling apart, and low self-esteem of the individual.

How Erection Occurs?

During sex, impulses from the brain allow the blood to fill blood in the chambers of the penis known as corpus cavernosa. This, in turn, will cause the penis to enlarge as blood fills, creating an erection. There is a membrane surrounding the corpus cavernosa called the tunica albuginea, which helps to trap the blood and that will subsequently lengthen the erection time.

What Are the Statistics?

It is a prevalent reproductive disorder that occurs in one out of five men. In Asia, the prevalence of erectile dysfunction (ED) is 7 to 15 % for 40 to 49 aged men and 39 % to 49 % for 60 to 70 aged men.

What Are the Possible Causes of Erectile Dysfunction?

Erectile dysfunction occurs due to deprived blood flow to the penis or the injury to vessels supplying it. Vascular, neuropathic, and psychological causes are common. It can also occur due to underlying medical conditions like heart diseases, atherosclerosis, kidney diseases, diabetes, stress, multiple sclerosis, and hypogonadism. Some drugs like beta-blockers and thiazide diuretics also can lead to erectile dysfunction.

What Are the Types of Erectile Dysfunction?

• Organic Erectile Dysfunction- Any abnormalities in the nerves, arteries, or veins supplying the penis can be classified under organic ED. In atherosclerosis, plaque deposition in the arteries can cause them to clog and leads to reduced blood flow. Any excess tissue growth or an abnormal curvature in the penis can also cause ED.

• Premature Ejaculation- Premature ejaculation is a condition in which the ejaculation of the semen occurs before penetration, and there is an inability to hold it until the penetration occurs.

What Are the Symptoms of Erectile Dysfunction?

1. The inability of the penis to erect or harden.

2. Erections that are not too hard for penetration.

3. Erections that are not hard often, and end before sexual satisfaction.

How to Diagnose Erectile Dysfunction?

Blood investigation is done to assess glucose, lipids, thyroid function tests, prolactin, testosterone, LH (luteinizing hormone), and FSH (Follicle-stimulating hormone).

Is Erectile Dysfunction Treatable Without Surgery?

1. The first line of treatment includes drugs that contain oral phosphodiesterase type 5 inhibitors, such as Sildenafil, which elevates cyclic guanosine monophosphate levels in smooth muscles of the corpus cavernosum, causing vasodilation and penile erection.

2. Urethral administration of prostaglandin E1 also has been proven to treat ED. It is a smooth muscle relaxant and vasodilator. This helps by allowing the smooth muscles to relax by arterial dilation. As a result of this, blood pools in the penis, causing an erection.

3. Testosterone therapy is done in case of hypogonadism or when there are low circulating levels of the hormone.

4. Vacuum constriction devices that achieve an erection by maintaining a tourniquet around the base of the penis. It is like a cylinder attached to the end of the penis. The cylinder, when pumped out, creates a vacuum and draws blood inside the penis, and an erection happens.

5. Penile injection therapy can be done by the individual himself. The individual is taught how to inject the medicine into the erection chambers. It will help relax the blood vessels that constrict the blood flow and cause an erection. The drugs commonly used are prostaglandin E1, Papaverine, and Phentolamine.

6. Sex therapy can be given to affected persons by trained professionals.

7. Shock wave therapy has been proven effective for the treatment of erectile dysfunction. It is non-invasive and less time-consuming. It helps stimulate the tissues and regrow the vessels that get to the penis.

8. Penile prosthetic implants are inserted in the erection chambers, and they help produce an erection during sex. Inflatable and malleable implants are the two types of implants used for the same. The implants are placed inside through a surgical procedure involving one or two incisions.

Can Physiotherapy Be Done for Erectile Dysfunction?

Non-surgical techniques include acupressure therapy and pelvic floor muscle training, also known as Kegel exercise. Kegel exercises help to strengthen the bulbocavernosus and ischiocavernosus muscles which in turn help blood flow to the penis during erection.

How Kegel Exercise Is Done?

To perform it, first, the individual has to find out which muscle to work on. Try controlling urine when trying to urinate. The muscles which are held to control are the ones that are going to be exerted or worked upon. After finding these muscles, try to clench them not so hard and squeeze them for 5 seconds, and then relax. Repeat for 10-20 sets twice or thrice a day. This should be done in the following positions:

1. Lying on the Floor Back Squeezes - Try to lie flat with the back and knees bent facing the ceiling. Draw the penis inwards and hold for five seconds and then release. Following this, try to squeeze the anal muscles mimicking to control bowel moment. Hold for another five seconds and release. Repeat the steps eight to ten times twice or thrice a day.

2. Lying on the Side Squeezes - Lie on the floor sideways. Keep both knees apart with the help of a pillow and try squeezing the legs together and hold for five seconds, and then release. Repeat the steps eight to ten times twice or thrice a day.

3. Sitting in a Chair Squeezes- Sitting in a chair, try to control the muscles mimicking to control urine. Squeeze the muscles for five seconds and release. Repeat the two steps eight to ten times twice or thrice a day.

What Precautions to Follow While Doing Kegel Exercises?

1. Do not attempt to do it if the methods are not understandable.

2. In case of an underlying disease like a lower limb fracture or any other abnormality, get help from a doctor.

3. Do not try to hold or control breathing throughout the exercise.

4. If there is pain while squeezing, discontinue doing it and seek the advice of medical personnel.

5. Do not push down the muscles while trying to squeeze.

6. Keep the stomach muscles relaxed.

7. Do not forget to relax the muscles after each squeeze.

How Is Auriculotherapy Done for Erectile Dysfunction?

It is a low-cost and safe technique for many conditions, including erectile dysfunction (ED). It is done by stimulating reflex points of the ear. It is also known as auricular acupuncture. Five pressure points need to be stimulated for this purpose. They are present on the following sites:

1. The angle of the wrist near the little finger.

2. In the foot near the big toe and second toe.

3. Inside of the leg above the heel and at the ankle.

4. Inside of the leg, four fingers above the ankle.

5. In the shin below the knee on the front side.

What Are the Natural Remedies to Prevent Erectile Dysfunction?

• Regular exercise and yoga can improve blood flow and will help strengthen the pelvic muscles. It also lifts mood and stamina.

• A healthy diet with nutrient-rich foods that enable circulation. Reducing junk food to prevent clogging of arteries and obesity.

• Reducing smoking and alcohol intake. Smoking is the underlying cause of many heart problems and can slow stamina.

• Reducing stress in any form.

Conclusion:

Erectile dysfunction is not as alarming as it sounds. Some lifestyle modifications and changes in food habits can greatly reduce the occurrence of erectile dysfunction. Also, there is modern medicine to treat erectile dysfunction and save patients.