title: Pelvic-floor muscle rehabilitation in erectile dysfunction and premature ejaculation.
abstract: BACKGROUND
  In men, involuntary or voluntary ischiocavernosus muscle contractions after erection lead to intracavernous blood pressures far higher than the systolic pressure, which builds and maintains penile rigidity. Thus, erectile dysfunction may be partly due to ischiocavernosus muscle atrophy and may be treated by rehabilitation interventions.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether pelvic-floor muscle strengthening interventions could be associated with increases in intracavernous pressure that would increase penile rigidity.
  
  
  METHODS
  An observational study was conducted.
  
  
  METHODS
  One hundred twenty-two men with isolated erectile dysfunction and 108 men with isolated premature ejaculation participated (no neuromuscular diseases or previous perineal rehabilitation). Thirty-minute sessions of voluntary contractions coupled with electrical stimulation were designed to increase ischiocavernosus muscle strength (monitored through intracavernous pressure increase). A linear mixed-effects model per group analyzed separately, then jointly, the maximum change in pressure (ΔP) and the maximum baseline (ie, respectively, the average contraction-generated difference in intracavernous pressure and the intracavernous pressure plateau at full erection, both measured during the highest moving average of the best 2 minutes of each session).
  
  
  RESULTS
  Over 20 sessions, the maximum ΔP increased in erectile dysfunction as well as in premature ejaculation (87% and 88%, respectively, in men with positive trends). The maximum baseline also increased (99% and 72%, respectively, in men with positive trends). The joint modeling indicated that the mean expected progressions of the intracavernous pressure after 5 sessions in erectile dysfunction and premature ejaculation were 62.85 and 64.15 cm H2O, respectively.
  
  
  CONCLUSIONS
  Indirect measurements were obtained of intracavernous pressure and ischiocavernosus muscle force.
  
  
  CONCLUSIONS
  Pelvic-floor muscle rehabilitation was found to be beneficial in erectile dysfunction. However, its effects on symptoms of premature ejaculation, despite intracavernous pressure gains, were much more difficult to assess. The definitive proof of its benefits requires rather difficult-to-design clinical trials.
authors.affiliation: P. Lavoisier, PT, MD, Centre d'Etudes des Dysfonctions Sexuelles (CEDS), 153 Rue Pierre Corneille 69003, Lyon, France. pierrelavoisier@wanadoo.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lavoisier
authors.affiliation: P. Roy, MD, PhD, Hospices Civils de Lyon, Service de Biostatistique; Université Lyon 1, Villeurbanne, France; and CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Bio Statistique Santé, Pierre-Bénite, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Roy
authors.affiliation: E. Dantony, MSc, Hospices Civils de Lyon, Service de Biostatistique; Université Lyon 1; and CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Bio Statistique Santé, Pierre-Bénite.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Dantony
authors.affiliation: A. Watrelot, MD, Centre de Recherche et d'Etudes de la Stérilité (CRES), Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Watrelot
authors.affiliation: J. Ruggeri, MD, Centre d'Etudes des Dysfonctions Sexuelles (CEDS).
authors.forename: Jean
authors.initials: J
authors.lastname: Ruggeri
authors.affiliation: S. Dumoulin, MSc, Centre d'Etudes des Dysfonctions Sexuelles (CEDS).
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dumoulin
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D009127:Muscle Rigidity / Q000503:physiopathology; D009130:Muscle, Smooth / Q000503:physiopathology; D017773:Pelvic Floor; D010413:Penis / Q000503:physiopathology; D061686:Premature Ejaculation / Q000503:physiopathology / Q000534:rehabilitation*