Pelvic Floor Dysfunction and Erectile Dysfunction

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Key takeaways

• Weak pelvic floor muscles can prevent blood being trapped in the penis, causing erectile difficulties
• Daily pelvic floor exercises for 6–12 weeks may improve erection firmness and duration
• Oral ED medications work well alongside pelvic floor training and lifestyle changes
• See your GP if you have new ED, as it can signal heart disease or diabetes

What is pelvic floor dysfunction and how does it cause erectile dysfunction?

The pelvic floor is a group of muscles that stretch like a hammock from the pubic bone at the front to the tailbone at the back. In men, these muscles support the bladder and bowel, and they play a crucial role in sexual function [1]. During an erection, the pelvic floor muscles help compress the veins that drain blood from the penis, trapping blood inside and maintaining rigidity. They also contract rhythmically during ejaculation.

Pelvic floor dysfunction occurs when these muscles become weak, tight, or poorly coordinated. Weakness is particularly common after prostate surgery, with age, obesity, chronic constipation, or a sedentary lifestyle [2]. When the pelvic floor cannot contract effectively, blood may leak out of the penis too quickly, making it difficult to achieve or sustain a firm erection. This venous leak is one of the mechanisms linking pelvic floor dysfunction and erectile dysfunction.

Other causes of pelvic floor dysfunction include nerve damage from diabetes, pelvic trauma, or chronic straining. Some men develop overactive or tense pelvic floor muscles, which can also interfere with normal sexual function. A thorough assessment by a healthcare professional can identify whether pelvic floor issues are contributing to your erectile difficulties.

How is pelvic floor dysfunction assessed in men with ED?

If you are experiencing erectile dysfunction, your GP or a specialist may ask about urinary symptoms (such as leaking, urgency, or difficulty starting), bowel habits, and any history of pelvic surgery or injury [2]. These questions help identify whether pelvic floor dysfunction might be playing a role. A physical examination is sometimes performed, though many assessments rely on your symptom history.

In some cases, you may be referred to a specialist pelvic health physiotherapist. These professionals are trained to assess pelvic floor muscle strength, tone, and coordination. They may use internal examination techniques (similar to those used in women's health) or external assessment methods, depending on your symptoms and comfort. Biofeedback devices can also help visualise muscle activity and guide training.

It is important to see your GP if you develop new erectile dysfunction, as it can be an early warning sign of cardiovascular disease or diabetes [1]. Your doctor will also check for other contributing factors such as high blood pressure, cholesterol levels, medication side effects, and psychological wellbeing. Addressing pelvic floor dysfunction is often part of a broader treatment plan tailored to your individual needs.

When to seek specialist pelvic floor assessment

You may benefit from specialist assessment if you have persistent erectile difficulties alongside urinary leakage, pain during sex, or a history of prostate surgery. Men who have tried oral ED treatments without success may also find that pelvic floor training improves their response to medication. Your GP can refer you to a pelvic health physiotherapist or a urologist with expertise in sexual medicine.

At a glance

Pelvic floor exercises and lifestyle measures for erectile dysfunction

Pelvic floor muscle training, often called Kegel exercises, can strengthen the muscles that support erections. Research suggests that regular pelvic floor exercises may improve erectile function, particularly in men with weak pelvic muscles or after prostate surgery [2]. To perform a pelvic floor contraction, imagine you are trying to stop the flow of urine mid-stream or prevent passing wind. Squeeze and lift those muscles without tightening your buttocks, thighs, or abdomen.

A typical training programme involves holding each contraction for up to 10 seconds, then relaxing for the same length of time. Aim for three sets of 10 repetitions daily. It can take several weeks to notice improvement, so consistency is key. A pelvic health physiotherapist can provide personalised guidance, correct your technique, and progress your exercises as your strength improves.

Lifestyle measures also play an important role. Maintaining a healthy weight reduces pressure on the pelvic floor, while regular physical activity improves blood flow and cardiovascular health [1]. Avoiding heavy lifting, managing constipation, and reducing alcohol intake can all support pelvic floor function. Stopping smoking is particularly important, as it damages blood vessels and worsens erectile dysfunction. Combining pelvic floor training with these lifestyle changes offers the best chance of improvement.

Oral ED treatments and pelvic floor dysfunction

Oral medications known as PDE5 inhibitors are the first-line medical treatment for erectile dysfunction in the UK [2]. These include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). They work by relaxing blood vessels in the penis, allowing increased blood flow when you are sexually aroused. Importantly, they require sexual stimulation to work and do not cause automatic erections [3][4][5][6].

For men with pelvic floor dysfunction and erectile dysfunction, oral treatments can be particularly helpful when combined with pelvic floor exercises. The medication improves blood flow, while stronger pelvic muscles help trap that blood in the penis for a firmer, longer-lasting erection. Some men find that pelvic floor training improves their response to medication or allows them to use a lower dose.

Sildenafil is usually taken about one hour before sex and lasts around four to six hours [3]. Tadalafil can be taken on-demand (at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low dose [4]. Vardenafil works within 25 to 60 minutes [5], while avanafil is the fastest-acting option, often effective within 15 to 30 minutes [6]. Your prescriber will help you choose the most suitable option based on your lifestyle, other medications, and health conditions.

Starting treatment safely

All PDE5 inhibitors are prescription-only medicines in the UK and are supplied after an online consultation reviewed by a UK-registered prescriber. During the consultation, you will be asked about your medical history, current medications, and cardiovascular health to ensure treatment is safe for you. Never take these medicines if you use nitrates, nicorandil, or recreational drugs called poppers, as the combination can cause a dangerous drop in blood pressure [3][4][5][6].

Treatment options available at Cured Pharmacy

Cured Pharmacy is a GPhC-registered online pharmacy (GPhC 9012511) offering a range of licensed ED treatments after a clinical consultation. Sildenafil, the generic version of Viagra, is available from £0.45 per tablet (first order with code Ednew: £0.36). Tadalafil, the generic version of Cialis, starts at £7.95 (first order with code Ednew: £6.36). Both are clinically proven and widely prescribed across the NHS and private sector [3][4].

For men who prefer branded options, Viagra is available at £37.95 (first order with code Ednew: £30.36) and Cialis at £12.00 (first order with code Ednew: £9.60). Alternative PDE5 inhibitors include vardenafil at £16.95 (first order with code Ednew: £13.56) and Spedra (avanafil) at £20.95 (first order with code Ednew: £16.76). Avarante (tadalafil 10mg) is priced at £11.49 (first order with code Ednew: £9.19).

All treatments require completion of an online consultation, which is reviewed by a UK-registered prescriber. This ensures the medication is safe and appropriate for you, taking into account your medical history, current medications, and any underlying health conditions. Discreet packaging and fast delivery are standard, and the pharmacy team is available to answer questions throughout your treatment journey.

Important safety considerations for men with pelvic floor dysfunction and erectile dysfunction

While PDE5 inhibitors are safe for most men, certain medical conditions and medications require caution. You must not take these medicines if you use nitrates for angina (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational nitrites known as poppers [3][4][5][6]. The combination can cause a severe and potentially life-threatening drop in blood pressure.

If you take alpha-blockers for an enlarged prostate or high blood pressure (such as tamsulosin or doxazosin), you should be stable on that treatment before starting a PDE5 inhibitor, and you will need the lowest starting dose to minimise the risk of dizziness or fainting. Men taking potent CYP3A4 inhibitors, including some HIV medications (ritonavir, cobicistat), antifungals (ketoconazole, itraconazole), or antibiotics (clarithromycin), may need dose adjustments or should avoid certain PDE5 inhibitors altogether [3][4][5][6].

PDE5 inhibitors are not suitable if sexual activity is inadvisable due to severe heart disease, recent heart attack or stroke, very low blood pressure, or certain eye conditions such as previous sudden vision loss (NAION) [2]. Seek urgent medical help if you experience an erection lasting more than four hours, sudden loss of vision or hearing, or chest pain during sex. Always declare all your current medications and health conditions during your consultation, and never stop or change a prescribed medicine without professional advice.

Combining pelvic floor training with medication

There is no safety concern with performing pelvic floor exercises while taking oral ED medication. In fact, the combination may enhance results. Continue your pelvic floor training programme as advised by your physiotherapist, and use your prescribed medication as directed. If you have any questions about your treatment plan, speak to your prescriber or pharmacist for personalised guidance.

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision or hearing while taking ED medication – seek urgent medical help
• Chest pain during sexual activity – stop and call 999 if pain does not resolve quickly
• Severe dizziness or fainting after taking ED medication – seek same-day medical advice

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.