Erectile Dysfunction (ED) is defined as the inability to achieve or sustain an erection adequate for satisfactory sexual performance (1). Erection, a complex event, necessitates the interplay between neurological and vascular responses The objective of this randomized controlled trial was to investigate the impact of manual therapy (friction massage) and pelvic floor muscle (PFM) training on erectile dysfunction (ED), pelvic floor muscle thickness, and blood flow in the penile arteries and veins in men who have undergone prostatic adenectomy (PA).

This study employed a randomized, double-blinded, controlled trial design. Forty patients participated and were divided into two groups: intervention and control (n=20 per group). The intervention group received 10 sessions of pelvic floor muscle training and manual therapy, while the control group solely underwent pelvic floor muscle training. The recovery rate was measured using the International Index of Erectile Function 15 (IIEF-15) questionnaire and Erection Hardness Score (EHS). Sonographic factors were assessed using simple and Doppler ultrasound.

The intervention group exhibited significantly higher erectile function scores (F(1,37)=158.04, P<0.001, η2P=0.810) and a higher average total (IIEF-15) score (20.52) (F(1,37)=136.76, P<0.001, η2P=0.787) compared to the control group in the post-test assessment.

Comparison between the two groups revealed an increase in ultrasonic parameters such as the thickness of the ischiocavernosus and bulbospongiosus muscles, maximum systolic velocity, and minimum diastolic velocity of the cavernosal artery in the intervention group. However, the maximum blood flow vePFM training and friction massage play a significant role in managing ED following PA, positioning them as the primary treatment approach for men experiencing ED post-prostatectomy.locity in the posterior vein decreased

Sexual health is a pivotal aspect of human’s life that deserves substantial attention. The findings of this study underscore the significant role of pelvic floor muscle training and friction massage as cost-effective, easily learned by physiotherapists, side-effect-free, and accessible interventions in enhancing erectile function post-prostatic adenectomy. Consequently, these approaches should be regarded as primary modalities for addressing erectile dysfunction

Prota C, Gomes C, Ribeiro L, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, RCT. Inter jof IR . 2012;24:174-8
Roostayi M, Rahdar N. The role of physiotherapy in the treatment of men’s sexual dysfunction (erectile dysfunction and premature ejaculation): a review. Physio Q. 2022;30:30-7.
Davia J, Welty A. Manual therapy and education for physical therapy management of male chronic pelvic pain syndrome. The J of WPHPT. 2014;38:3-10.