how-to-choose-best-treatment-erection-problems

Starting therapy with the least invasive option seems a logical strategy.
Counseling is recommended because examination, evaluation and choice of therapy can be decided by the same health care professional- Sex Therapist.

Placebo can work wonders along with counseling.

Perineal muscle exercises have to be incorporated in 'Counseling Program', by the Sex Therapist.
Pelvic-floor exercises do not involve any risks, and they are painless. The dropout rate is less than for other interventions and treatment modalities. If treatment is successful, the erection is spontaneous, and this in contrast to injection therapy and use of a vacuum pump or penile prosthesis. The cost of the therapy is low, but the patient needs to be motivated to perform the exercises 90 times daily at home for a period of 4 months.

Results indicate the need for further investigation. Randomized controlled trials are needed to define the efficacy of physical therapy in the treatment of erectile dysfunction.

Conclusion

Comparing the results of a protocol that can be administered by a physical therapist reported here with other interventions shows that a pelvic-floor muscle program is a possible noninvasive alternative to treat patients with erectile dysfunction caused by venous occlusion.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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counseling-best-treatment-erectile-dysfunction

COUNSELING/GUIDANCE/PSYCHOSEXUAL THERAPY/PSYCHOTHERAPY

Counseling is the BEST treatment for Erectile Dysfunctions.
Even if other treatment is used Counseling has to be added to the treatment.

COUNSELING IS BEST

PROS
Psychotherapy may be the intervention of choice for the patient with primarily nonorganic erectile dysfunction, such as that caused by depression. Psychotherapy can be valuable as an addition to medical or surgical interventions.

CONS
Unfortunately, there are very few follow-up studies examining the long-term effect of this intervention. Withdrawal from psychotherapy is common.

Scientifically speaking, the lack of a placebo control group and random allocation of patients to groups in study and in other trials using these approaches limit the usefulness of the results.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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perineal-exercise-treatment-erectile-dysfunction

Excerpt from study on Erectile Dysfunction and Pelvic Floor Exercises.

Different treatment options are available:
psychosexual counseling,
medication,
use of external vacuum devices,
intracavernous injection therapy,
vascular surgery, and use of a
penile prosthesis.

These exercises are known by different names

PELVIC FLOOR
PERINEAL MUSCLE
PUBOCOCCYGEUS MUSCLE
KEGEL'S EXERCISE

RESULTS
In this study, 47% of the patients regained normal erectile function, and 24% had an improved erection after a pelvic-floor re-education program in combination with EMG biofeedback and electrical stimulation. Six out of 51 patients requested another modality of therapy after cessation of the physical therapist intervention.

The results of study are in the line with the findings of

Mamberti-Dias and Bonierbale-Branchereau and Claes and colleagues.
The results of Schouman and Lacroix for patients with erectile dysfunction were less favorable, but their sample size was small.
Colpi et al reported that only 36% of the patients in their study recovered or improved following pelvic-floor muscle exercises for venogenic impotence.


BENEFITS OF PELVIC FLOOR EXERCISES
Physical therapy interventions provide noninvasive methods that are easy to perform, painless, and inexpensive. Studies have shown positive results after a pelvic-floor re-education program for men with erectile dysfunction. However, different programs were used, and some studies had a small sample size. Data from subjects who did not complete the studies were not included in the analyses, and predictive factors were not investigated. The aims of our study were to test an outpatient pelvic-floor re-education program in men with erection problems and to identify factors that could predict therapeutic outcome.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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what-is-erectile-dysfunction

WHAT IS ERECTILE DYSFUNCTION?
Erectile dysfunction is defined as the persistent failure to achieve and sustain erections of sufficient rigidity for penetration during sexual intercourse.

CAUSES OF ERECTILE DYSFUNCTION
Erectile dysfunction often has multiple causes. Therefore, the diagnostic evaluation for this disability should include an evaluation of the findings of an examination of the patient's psychological, hormonal, neurological, and vascular status. (1) In many cases, a combination of factors is involved.

The role of the perineal muscles in the erectile mechanism is still open for debate. Some studies using animal models as well as studies of humans have demonstrated evidence that there is normally increased ischiocavernous and bulbocavernous muscle activity during coitus. This muscle activity contributes to the increase in intracavernosal pressure.

A Controlled Study to Evaluate the Impact of a Psychosexual Assessment on Treatment Adherence and Satisfaction in Men with Erectile Dysfunction
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