Erectile Dysfunction and the pelvic floor

Erectile dysfunction (ED) affects around 1 in 5 men over the age of 40 — and yet, it’s rarely talked about. While medications like Viagra can help in the short term, they don’t address one of the most overlooked contributors to ED: your pelvic floor muscles.

So, what does the pelvic floor have to do with erections?

The pelvic floor is a group of muscles that stretch from the pubic bone at the front to the tailbone at the back. Among other things, these muscles:

• Support the bladder, bowel, and prostate

• Help control urination and bowel movements

• Play a key role in sexual function

During arousal and erection, these muscles help compress veins in the penis to trap blood and maintain firmness. They also contribute to ejaculatory control and sensation.

If these muscles are too weak, uncoordinated, or overactive, they may not support the erectile process effectively.

What Causes Pelvic Floor-Related ED?

• Sedentary lifestyle or poor core strength

• Chronic stress and tension (which can over-activate the muscles)

• Cycling or prolonged pressure to the perineum

• Pelvic surgery (e.g. prostatectomy)

• Long-term constipation or straining

• General deconditioning with age

How Do You Know If Your Pelvic Floor Is Involved?

You might benefit from pelvic floor treatment for ED if you also experience:

• Urinary leakage (especially post-prostate surgery)

• Constipation or bowel straining

• Lower back or pelvic pain

• A sense of tension in the perineum or buttocks

• Difficulty relaxing during sex

What Can Help?

Pelvic Floor Muscle Training

A pelvic floor physiotherapist can teach you how to correctly contract and relax your pelvic floor muscles (hint: it's not just about squeezing). Many men unknowingly brace their abs, glutes, or breath-hold — which can make things worse. A pelvic floor physio can assess the pelvic floor via transperineal ultrasound (on the space between the penis and anus), abdominal ultrasound and via internal rectal exam. 

Breath-work and Relaxation

An overactive pelvic floor is just as problematic as a weak one. Diaphragmatic breathing and pelvic floor relaxation techniques are essential parts of ED rehab. Find videos here. 

Targeted Release Work

If tension or trigger points are contributing to your symptoms, tools like a pelvic floor wand can help release and retrain the muscles internally and externally.

Should You Use a Penis Pump?

Penis pumps (vacuum erection devices) can be a helpful part of ED treatment — especially if used in conjunction with pelvic floor muscle training.

Here’s how they work:

• A pump creates a vacuum around the penis, drawing blood into the tissue and creating an erection.

• A constriction ring (used briefly) helps maintain the erection.

Benefits:

• Improves blood flow to the penis

• Can be used as part of post-prostatectomy rehab

• May help improve tissue health and sensation over time

Pumps don’t replace pelvic floor function, but they can complement a rehab program by encouraging circulation and tissue healing.

Ask your physiotherapist or GP about appropriate use and safety guidelines.

If you’re experiencing erectile dysfunction and haven’t looked into your pelvic floor, now’s the time. You don’t have to live with frustration or rely solely on medication — there are practical, body-based solutions that can restore function and confidence.