ERECTILE DYSFUNCTION
Erectile Dysfunction: Pelvic Floor Physical Therapy in NYC.
Erections that are harder to get, harder to keep, or less firm than they used to be. Medication that helps, but not fully. Pelvic tension or discomfort that showed up around the same time.
Erectile dysfunction has many causes, and some of them are medical problems your physician needs to rule out first. The pelvic floor muscles are also directly involved in erection. When those muscles are weak, overly tense or poorly coordinated, physical therapy can assess and treat that part of the picture.
UNDERSTANDING YOUR SYMPTOMS
Where the pelvic floor
fits in.
Erectile dysfunction means ongoing difficulty getting or keeping an erection firm enough for sex. Blood flow, nerves, hormones, medications, sleep, stress and overall health all play a role, which is why a physician evaluation comes first.
The pelvic floor plays a role too. Two of these muscles wrap the base of the penis and help trap blood during an erection. If they can’t contract well, erections may fade. If they are constantly guarded and tense, the problem often comes with pelvic pain, discomfort after ejaculation or a hard flaccid pattern instead.
The men we see most often for ED fall into three groups: ED alongside pelvic pain or tension, ED with a hard flaccid presentation, and ED after prostate surgery.
Signs the pelvic floor may be involved
- Erections that start but fade quickly
- Medication helps, but less than expected
- Pelvic, perineal or groin discomfort
- Pain during or after ejaculation
- A penis that feels firm, retracted or “off” at rest
- Urinary symptoms, such as dribbling or a weak stream
- Symptoms that began after prostate or pelvic surgery
- Symptoms that worsen with stress, sitting or cycling
Normal morning or nighttime erections alongside ED can point away from a blood flow problem. Mention it at your visit.
WHY THE PELVIC FLOOR MATTERS
What we assess,
and how we treat it.
Every session is one-on-one with Dr. Joshua Weber, PT, DPT, in a private treatment room. Nothing is done without explanation and your agreement, and you set the pace.
A tense pelvic floor and a weak one call for opposite treatment. Strengthening muscles that are already guarded can make symptoms worse, and relaxation work alone won’t help muscles that can’t contract.
The evaluation tells us which you have, so your plan fits your findings instead of a generic list of Kegels.
How treatment works at Pelvic Lab
- 01
Hands-on manual therapy
To reduce tension and tenderness in the pelvic floor and surrounding muscles, including internal treatment only when appropriate and with your consent.
- 02
Relaxation and breathing
Training the pelvic floor to fully let go at rest, which a guarded pelvic floor often can’t do on its own.
- 03
Strength and control
Targeted strengthening when testing shows weakness, progressed toward the quick, strong contractions erections rely on.
- 04
Post-surgical recovery
Coordinated with your urologist’s plan after prostatectomy, alongside continence training.
- 05
Pressure and stress
Addressing the anxiety cycle around sexual performance, and knowing when to bring in a sex therapist.
- 06
A home program
Exercises and habits to use between visits, adjusted as you progress.
We can’t promise a result. In the best-known trial of pelvic floor training for ED, 40% of men regained normal erectile function after six months, about a third improved and about a quarter did not (Dorey et al., 2005). That study used strengthening, which is why we test first.
YOUR FIRST VISIT
A 45-minute
evaluation.
We’ll review your symptoms, medical history, medications and previous treatments, and talk through your goals. The physical assessment may include breathing, movement, the hips, abdomen and pelvic floor, and every part is explained first.
You’ll leave with a clear explanation of what we found, whether physical therapy is the right fit for you, and a recommended plan of care.
WHEN TO SEE A PHYSICIAN FIRST
Medical care
comes first.
Erectile dysfunction can be an early sign of heart disease, diabetes or a hormone problem. If you haven’t seen a physician or urologist about it, start there. Don’t stop or change a prescribed medication without talking to your prescriber.
Physical therapy works alongside medical care, not in place of it.
Seek prompt medical care for:
- An erection lasting more than 4 hours (emergency)
- Chest pain or shortness of breath during sex (emergency)
- Sudden penile pain with a popping sound, bruising or swelling after sex (emergency)
- New numbness in the groin or saddle area with changes in bladder or bowel control (emergency)
- A new lump, curve or indentation in the penis
FREQUENTLY ASKED QUESTIONS
A few things
you may be wondering.
Can physical therapy help erectile dysfunction?
It can when the pelvic floor is part of the cause. It is less likely to help when ED comes mainly from blood vessel disease, nerve damage or low testosterone. The evaluation is how we find out which applies to you.
Should I just do Kegels?
Not without an assessment. Many men with ED, especially those with pelvic pain, already have a pelvic floor that’s too tense, and adding Kegels can make things worse. Others genuinely need strengthening. Testing tells us which.
Can I keep taking my ED medication?
Yes. Physical therapy doesn’t replace medication, and many men use both. Any change to a prescription is a decision for you and your prescriber.
Is it ED or hard flaccid?
They overlap. ED is difficulty getting or keeping an erection. Hard flaccid involves changes in the penis at rest, often with other symptoms. See Hard Flaccid vs. Erectile Dysfunction.
Is an internal exam required?
No. An internal pelvic floor assessment can be useful, but it is always optional. We’ll explain why it may or may not help, and you decide. You can pause or stop any part of care at any time.
Do I need a referral?
No. In New York, qualified physical therapists can treat without a referral for up to 10 visits or 30 days, whichever comes first.
Do you take insurance?
Pelvic Lab is a direct-pay practice. We provide a superbill you can submit to your insurance company for possible out-of-network reimbursement. Coverage depends on your plan.
YOUR NEXT CHAPTER STARTS WITH A CONVERSATION
Specialized pelvic floor care
for men in Manhattan.
16 Madison Square West, Suite 1047, in the Flatiron District.
Book your evaluation, or speak with Dr. Weber first.