Erectile dysfunction is a type of sexual dysfunction in which a patient is unable to achieve or maintain an erection firm enough for sexual satisfaction.

This condition can also include symptoms of low libido, anxiety, and frustration. More specifically, erectile dysfunction be defined as any of the following scenarios:

• Being completely unable to achieve an erection
• Being able to achieve an erection, but only occasionally
• Being able to achieve an erection, but not long enough for intercourse
• Requiring a lot of consistent stimulation in order to maintain an erection

There are different types of erectile dysfunction with differing causes. Because of this, it may be helpful to understand how an erection works in basic terms:

Firstly, the hormone testosterone allows for arousal and the ability to begin an erection by stimulating nerves that affect blood flow to the penis.

As you become aroused, the brain sends signals that allow the blood vessels within the penis to become filled with blood, where it will stay for some time. This blood flow allows the penis to become erect and firm—also known as an erection.

This blood is able to stay in the penis and maintain the erection thanks to the pelvic floor muscles, which contract to hold it there. An erection typically goes away after ejaculation, but can also go away without ejaculation.

So, now that you have an understanding of how erections work, let’s look at the different types of erectile dysfunction:

Vascular erectile dysfunction 

• This is the most common type of erectile dysfunction, which occurs when something disrupts blood flow to the penis.

Neurogenic erectile dysfunction 

• This type of erectile dysfunction is caused by problems with the nerves, which prevents the brain from sending signals necessary to start an erection.

Hormonal erectile dysfunction

• A lack of testosterone can prevent arousal and blood flow to the penis, making erections more difficult.

Psychogenic erectile dysfunction

• Erectile dysfunction caused by depression, anxiety, stress, or other psychological factors.

Erectile dysfunction is actually much more common than you may realize, and many cases go unreported—likely due to embarrassment and avoidance. However, there is no reason to feel shame in experiencing sexual dysfunction or seeking treatment.

Every person deserves to be in good health, and that includes sexual health! Hive is here to be your motivator, so don’t avoid the treatment and care you deserve.

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Occasional erectile dysfunction is not usually anything to worry about, as many things can cause sexual dysfunction. Being nervous or anxious, drinking alcohol, and even some medications may cause erectile dysfunction.

However, frequent or prolonged erectile dysfunction is a condition that should be treated by a professional.

Erectile dysfunction can be caused by a combination of physical and psychological factors. In terms of physical causes, an erection involves the brain, hormones, muscles, nerves, and blood vessels.

Therefore, there are numerous physical causes of ED, including (but not limited to) the following:

Underlying Conditions

• Heart disease
• High cholesterol
• High blood pressure
• Diabetes
• Parkinson’s disease
• Multiple sclerosis

Hormonal Factors

• Low testosterone

Lifestyle Factors

• Alcohol
• Medications
• Tobacco use

Neurological Factors

• Pudendal nerve dysfunction
• Conditions of the nervous system that may disrupt arousal signals

Previous Injury, Illness, or Surgery

Injuries to the genital region can cause the formation of scar tissue in the penis (known as Peyronie’s disease) that can cause pain and erectile dysfunction.

Additionally, injuries or surgeries can cause nerve damage and pelvic floor weakness that can contribute to erectile dysfunction.

Pelvic Floor Dysfunction

The pelvic floor plays a major role in many bodily functions—all of which are done through contraction and relaxation. It allows for sexual function and appreciation, such as aiding in arousal, maintaining erections, and allowing for ejaculation. The pelvic floor also allows for urinary and bowel functions!

When these muscles become too tight, weak, inflexible, or poorly coordinated, this is known as pelvic floor dysfunction. Pelvic floor dysfunction can have a very wide range of symptoms.

Some examples include incontinence, constipation, pelvic pain, and, in the case of sexual function, erectile dysfunction.

As described earlier, an erection is the process of blood entering the penis and staying there, which allows for lift and firmness.

The pelvic floor muscles allow proper blood flow to the penis during arousal, and helps support an erection by contracting and keeping the blood in the penis (allowing firmness) as needed during intercourse.

However, pelvic floor dysfunction can make it difficult to maintain or initiate an erection. Having pelvic floor tension can affect the flow of blood into the penis; on the other hand, pelvic floor weakness can affect the vein compression necessary to maintain erections.

Having poorly coordinated pelvic floor muscles can also result in difficult or short erections. As you can see, the pelvic floor is very important for proper sexual function! 

Many things can cause pelvic floor dysfunction: Injuries, surgeries, poor posture, misalignment, prolonged sitting, poor urinary or bowel habits, stress, anxiety, and much more.

Regardless of what is causing your pelvic floor dysfunction, Hive’s pelvic floor therapists will be able to help!

Psychological Factors

Things like stress, depression, or anxiety can not only contribute to pelvic floor tension, but also decreased sex drive and arousal.

Additionally, experiencing difficulties with maintaining erections can cause anxiety, nervousness, or stress—creating a cycle of erectile dysfunction and pelvic floor problems.

Psychological elements can be powerful factors in erectile dysfunction. Stress, anxiety, and other emotions may be caused by:

• Embarrassment or frustration from erectile dysfunction
• Worries of sexual performance
• Past emotional or physical trauma
• Previous negative experiences with sex
• Religious or cultural effects on sexuality

It is crucial not to ignore the psychological aspects of pelvic floor dysfunction completely.

Our pelvic floor physical therapists at Hive Therapy and Wellness value holistic care, and believe it is essential to collaborate with other health professionals—sex therapists, mental health specialists, and urologists—in order to curate the best care experience possible!

We want to help you meet your goals, and are here to provide support in any way we can.

Pelvic floor physical therapy can support healthy sexual function and treat erectile dysfunction by improving pelvic floor muscle strength, reducing muscle tension, supporting better blood flow, and helping patients gain confidence through consistent treatment and at-home practice.

There are many treatments that pelvic floor therapists can utilize to meet these goals!

However, while our pelvic floor physical therapists are highly trained and educated, they are also aware that each person has a different level of comfort regarding examination and treatment.

Hive Therapy and Wellness is here to listen to your needs and help you feel comfortable and confident during treatment.

Our physical therapists will always request consent before examination or treatment, and you are always allowed to rescind that consent at any point in time. Treatment should always match your comfort level!

So, to start treatment for erectile dysfunction, your physical therapist will first discuss your symptoms and medical history, as well as perform an evaluation (with your consent).

They may also assess other areas that affect the pelvic floor, such as the pelvis, hips, back, and abdominals.

With this information, they will curate a comprehensive treatment plan, which may include treatment methods such as the following:

Pelvic Floor Training

Pelvic floor training is an important form of treatment for erectile dysfunction. It allows you to improve your understanding and control of your pelvic floor, and improve the strength and flexibility of your pelvic floor muscles.

To help you feel and activate your pelvic floor, you can expect education and a variety of exercises that will allow you to better understand this essential part of your body. These treatments and exercises are known as neuromuscular re-education and biofeedback.

These will allow you to become more familiar with sensations of the pelvic floor, improve your control of those muscles, and learn how to relax or contract them voluntarily.

Some pelvic floor training exercises may involve tools used internally via the rectum. These tools can be very helpful in teaching you to strengthen and relax your pelvic floor!

Additionally, you can expect exercises or practice that can help build pelvic floor strength, or relaxation techniques to help relieve tension.

Manual Therapy

Manual therapy is a very useful treatment for addressing pelvic floor tension and tightness that may be contributing to erectile dysfunction.

Manipulation and mobilization of muscle tissue can also aid in nerve function, which can alleviate irritation and reduce hypersensitivity.

Manual therapy involves hands-on techniques or the use of tools that manipulate muscle tissue in order to encourage relaxation and relieve trigger points.

Manual therapy can be done externally to areas such as the pelvis, hips, abdominals, or lower back, as well as internally via the rectum.

Behavioral Modifications

Hive Therapy and Wellness values holistic care and long-lasting results—therefore, they will identify any behaviors that could be contributing to your pelvic floor tension and causing difficulty with achieving an erection.

Many things can contribute to pelvic floor tension, even stress and anxiety, so you can expect to learn some relaxation techniques such as diaphragmatic breathing.

Other aspects that your physical therapist may look to correct include your posture and alignment. Misalignment or poor posture habits can put pressure on the pelvis and contribute to pelvic floor tension; therefore, your pelvic floor therapist may provide treatment to correct these.

They may also provide guidance and advice for hydration, fiber intake, toilet posture, and habits to avoid in the restroom. The daily behaviors that can cause pelvic floor tension may surprise you!

Exercise and Flexibility

Similarly to poor posture, muscle imbalances can also cause tension on the pelvic floor. If your hips, back, abdominals, and pelvis are imbalanced, you may be unknowingly causing tension in the pelvic floor.

To help prevent excess pressure on the pelvis, your physical therapist will curate an exercise and stretching routine just for you!

Regular exercise can also help encourage better blood flow and circulation, so it is especially important for treatment of erectile dysfunction.

Additionally, stretching can help improve the mobility and flexibility of your muscles, which is necessary to improve blood flow in the pelvic area.

Education

Lastly, education plays a massive role in treatment. Your pelvic floor therapist can teach you many things thanks to their many years of training and experience.

They can provide information about the pelvic floor, sexual function, your condition, and much more. They’ll also provide instruction for at-home care and pelvic floor practice, of course.

There are many different treatments available through Hive Therapy and Wellness. Your pelvic floor physical therapist will always curate a treatment plan based on your unique case and individual needs; therefore, your treatment plan may include any of the following:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback