Erectile Dysfunction (ED)

Erectile Dysfunction involves the inability to achieve or maintain an erection suitable for sexual activity. Pelvic floor muscle dysfunction, reduced penile blood flow, and poor neuromuscular control can contribute to ED. Studies show that Pelvic Floor Muscle Training (PFMT) enhances erectile function by improving ischiocavernosus and bulbocavernosus muscle function, promoting better venous occlusion and erection quality.

Hypertonic Pelvic Floor (HPF)

HPF is when the pelvic floor muscles become excessively tense and fail to relax, often leading to pain and dysfunction in the pelvic region. It  may also involve tightness in adjacent muscles such as the piriformis, obturator internus, coccygeus, and hamstrings. Hypertonicity can be caused by chronic core engagement, prolonged holding of urine or bowel movements, high levels of stress or anxiety, or trauma, such as a fall to the tailbone. Treatment focuses on pelvic floor relaxation, manual therapy, and tailored hip exercises to improve flexibility and restore normal function.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

CP/CPPS is a multifactorial condition involving pelvic muscle dysfunction, nerve hypersensitivity, and psychosocial factors. Treatment involves pelvic floor relaxation, manual therapy, myofascial release, and neuromuscular techniques to reduce muscle hypertonicity and restore normal function.

Pudendal Neuralgia (PN)

Pudendal Neuralgia presents as burning, tingling, or shooting pain in the perineal region, often aggravated by sitting. Nerve mobilisation, pelvic floor inhibition, and transcutaneous electrical nerve stimulation (TENS) help alleviate symptoms by reducing neural irritation.

Hard-Flaccid Syndrome (HFS)

Hard-Flaccid Syndrome (HFS) is characterised by persistent semi-rigid erections, penile pain, numbness, reduced sensitivity, and impaired sexual function. Manual therapy, pelvic floor relaxation techniques, and neuromuscular re-education can help release chronic tension and restore function.

Peyronie’s Disease (PD)

Peyronie’s Disease (PD) involves curvature of the penis due to plaque formation, often resulting in pain and erectile dysfunction. Treatment modalities include Low-Level Laser Therapy (LLLT) to soften plaque and improve tissue elasticity, combined with scar therapy techniques such as manual mobilisation and soft tissue manipulation to enhance tissue flexibility and restore penile mobility. Other approaches to help reduce plaque include therapeutic ultrasound and extracorporeal shock wave therapy (ESWT).

Post-Micturition Dribble (PMD)

Post-Micturition Dribble (PMD) involves residual urine leaking after urination due to incomplete urethral emptying. Weakness in the bulbocavernosus muscle contributes to inadequate expulsion of urine. PFMT, with emphasis on strong, coordinated contractions post-voiding, helps to expel residual urine, preventing dribble. Manual compression of the urethra can complement PFMT for more effective results.

Post-Prostatectomy Incontinence

Incontinence following prostate surgery, particularly stress urinary incontinence (SUI), is a common complication. PFMT, neuromuscular re-education, and biofeedback can significantly improve continence outcomes by enhancing pelvic floor muscle strength and coordination.

Pelvic Floor Muscle Training (PFMT)

PFMT is a cornerstone of treatment for various pelvic conditions. It strengthens both slow-twitch (endurance) and fast-twitch (power) fibres of the pelvic floor, improving urinary and sexual function. Effective PFMT includes:

• Endurance Training: Sustaining 20% of maximal contraction over increasing time intervals.
• Agility Training: Performing rapid contractions (“quick flicks”) to improve reflexive control.
• Coordination and Relaxation: Ensuring the ability to both contract and relax the muscles properly.

Download Journal Article – PFMT in Males

Manual Therapy and Soft Tissue Manipulation

Manual therapy includes myofascial release, trigger point therapy, and scar mobilisation to address tissue adhesions, improve mobility, and reduce pain. Techniques like skin rolling and tissue mobilisation to the tunica albuginea, corpus cavernosum, and associated penile fascia, can improve blood flow and reduce curvature, which is crucial for conditions like PD.

Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromuscular Stimulation (NMS)

TENS and NMS modulate nerve activity to reduce pain and improve neuromuscular function. NMS enhances pelvic floor strength and improves muscle coordination, playing a critical role in addressing urinary incontinence. NMS targets key pelvic floor muscles, including the pubococcygeus, bulbocavernosus, and external urethral sphincter, to restore sphincter control and bladder support. By stimulating these muscles, NMS promotes stronger, sustained contractions, improving continence and reducing leakage.

Low-Level Laser Therapy (LLLT)

LLLT (also known as Photobiomodulation Therapy or PBMT) using a 904 nm wavelength has shown promising results in improving nerve regeneration, reducing inflammation, and enhancing tissue healing. It is particularly beneficial in cases of post-prostatectomy recovery, scrotal lymphoedema, and erectile dysfunction.

Download Systematic Review – PBMT in Peripheral Nerve Regeneration

Scar Tissue Therapy

Post-surgical scarring can lead to adhesions and restricted tissue mobility. Scar mobilisation techniques, combined with manual therapy, can reduce fibrosis and improve tissue elasticity, which is critical in post-prostatectomy, orchiectomy and penile surgeries.