Pelvic floor muscle training (PFMT) may improve erectile function and climacturia in men who have undergone prostatectomy, according to Belgian researchers.
Erectile dysfunction (ED) is common after such surgery. While medications like phosphodiesterase type 5 inhibitors can help, research suggests more than over 50% of men stop taking them because they aren’t effective.
Climacturia – incontinence that occurs with orgasm – affects 22% to 43% of men after prostatectomy, the researchers noted. As a result, some men feel anxious about sex and might avoid it altogether.
In past studies, PFMT has improved erectile function in men with ED. For this project, the researchers questioned whether men with ED and climacturia after prostatectomy would benefit.
Their study involved 33 men who had undergone prostatectomy and experienced ongoing ED for twelve months after surgery. Some also had climacturia. (Over time, some data was lost to follow up.)
Prior to surgery, the men completed the International Index of Erectile Function (IIEF), a questionnaire designed to assess erections, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. The men also reported whether they had climacturia and described the quality of their erections (including hardness, length, tumescence, elevation, and persistence).
The men were randomly assigned to one of two groups. Sixteen men (mean age 61.1 years) started PFMT immediately. The remaining 17 men (mean age 61.5 years) began treatment 15 months after surgery and served as the control group.
Men attended PFMT sessions with the same therapist, working on the strength and endurance of the pelvic floor muscles. Overall, therapy lasted for three months. Patients were instructed to follow a daily home program during this time. Other ED treatments were not allowed during the treatment period.
The researchers analyzed the data in two phases. First, they compared the results of the two groups at the 15-month point, when the treatment group had finished therapy and the control group was about to start.
IIEF scores at this time showed that men who had received PFMT had improved erectile function compared to controls, but scores on the other domains were not significantly changed for either group.
The treatment group also saw improved hardness, length, tumescence, and elevation compared to the controls, although persistence of erection did not change considerably.
More men in the treatment group had improvements in climacturia as well.
In the second phase, the researchers analyzed overall data for both groups after PFMT.
After three months of therapy, the IIEF domains of erectile function and sexual satisfaction had significantly improved, although the other domains remained unchanged. Erection quality was better and climacturia decreased significantly.
Five of thirty patients had normal erections after therapy. Intercourse was possible for another seven men, although their erections were not always suitable. Eighteen men still had moderate-to-severe ED.
What made PFMT effective for some men? The researchers explained that contraction of the pelvic muscles helps blood stay in the penis, keeping the erection firm.
They added that PFMT could be a starting point for men after prostatectomy. Because PFMT is painless and not invasive, patients may be more likely to stick with it. Also, men may be able to achieve spontaneous erections. This is not possible with other therapies, such as vacuum pumps, prostheses, medications, and injections.
Some men may still need medication, the authors acknowledged. Future research may focus on combining PFMT with ED drugs, as PFMT may be effective enough to lower drug doses, reducing the risk of side effects.
The study was published last month in the International Journal of Impotence Research.
International Journal of Impotence Research
Geraerts, I., et al.
“Pelvic floor muscle training for erectile dysfunction and climacturia 1 year after nerve sparing radical prostatectomy: a randomized controlled trial”
(November 5, 2015)