Both are common, treatable, and more prevalent in younger men than most people think. Each has physical and psychological contributors, and pelvic floor physiotherapy can help with erections, control and confidence.
Erectile dysfunction (ED) is when the erectile firmness (called tumescence) of the penis is inadequate or inconsistent. This can mean difficulty getting a partial or full erection, being limited to a partial or semi-erection that is not firm enough for penetration or other sexual gratification, or losing firmness prematurely. We tend to think of ED as an older person's condition, but up to 35% of men under 40 experience some form of it at least occasionally. There are both physical and psychological contributors, some more easily modifiable than others.
Premature ejaculation (PE) is, as it sounds, when you orgasm or ejaculate earlier than intended without being able to hold off or delay, often with little warning that it is about to happen. It can occur alongside ED or on its own, and can be driven by hypersensitivity of the genitalia or an over-reactive orgasm reflex, as well as pelvic floor muscle, blood flow, psychological and lifestyle factors. There is no universally agreed cut-off time, but 2 minutes is often used as a benchmark, with up to 21% of men affected.
ED and PE can occur together, one can precede the other, and in some cases one can cause the other, though not always. The psychology of sexual dysfunction can create a chicken-and-egg effect, where difficulty getting erect leads to ejaculating before the erection fades, which can become a subconscious habit. Beyond the direct psychology of sex, there are other physical and psychological causes.
During your first visit, I'll go through what has brought you in and the contributing factors, both lifestyle and medical or surgical, anything you have already tried, and what your main goals are. I'll also ask about your current and previous sexual habits, and whether there have been any changes to habits, partners, or other relevant factors.
To diagnose accurately and build a treatment plan, I'll assess the pelvic floor. This is done externally around the genitalia to check for any contributing factors there, along with the pelvic floor muscles at the base of the penis, which can be seen and palpated around the perineum (the region between the testes and the rectum). In most cases there is no need for an internal examination, but ultrasound of the deeper pelvic muscles through the perineum (the probe resting on the gooch) can provide extra information.
After the examination, treatment usually begins in the same session and often involves training the pelvic floor muscles in some way - activation or co-ordination if the muscles are hard to feel working, or relaxation and down-training if they are overactive and preventing adequate blood movement and pooling for erections, or causing over-stimulation and over-engorgement of the penile head. If I find other contributing factors during our initial discussion, I can also introduce changes to sexual or other bedroom habits, stress and fatigue management, and where useful the use of devices like cock rings and penis pumps to help things along.
All of this is packaged into a plan to continue at home between sessions, where I monitor your progress and increase the intensity or complexity of the exercises and adjust the program as you improve.
Consent is ongoing, specific, and yours to withdraw at any time.
Physiotherapy, even without assistive medication like Viagra or Cialis, has been shown to improve around 75% of erectile dysfunction cases, though it takes a bit of time to get results. Like any other muscle group, the pelvic floor muscles that often need training (alongside optimising the medical and lifestyle factors) take time to strengthen - you can't get a six-pack overnight, and you can't get erection-sustaining pelvic muscles overnight either. Some people respond quicker if they have fewer lifestyle factors, and some have a better mind-body connection with the pelvic floor and build strength and co-ordination faster. Usually within the first six weeks I'll have an idea whether alternative strategies need to be considered alongside pelvic muscle training and lifestyle optimisation.
Pelvic muscle training, alongside desensitisation and re-sensitisation or re-exposure strategies, has around an 80% success rate in delaying time to ejaculation at first penetration or insertion, as well as improving control near the point of ejaculation, the ability to stave it off for longer, and overall awareness of your journey towards orgasm. As with ED, there is a time factor, but effects are usually noticeable within the first 6 weeks and continue to improve to around 12 weeks. People with either lifelong or acquired (later-onset) PE benefit from pelvic floor physiotherapy, though they often need to continue their exercises for a few months after improving to help solidify the gains.
You do not need a referral from anyone to see me. Referrals from your GP (a standard or Medicare EPC referral) or a specialist (urologist, sexologist, psychologist or sex psychologist) are welcome, but you are free to book without having seen any medical professional or having a referral. If, in the initial consultation, I identify medical factors contributing more than physiotherapy can help with, I can refer you on to a specialist who is better equipped, but that is only in rare cases.
Not sure if I'm who you need? Ask me and I'll let you know if physiotherapy is the right fit, or point you to who is.