Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction

Br J Gen Pract. 2004 Nov;54(508):819-25.


Background: The pelvic floor muscles are active in normal erectile function. Therefore, it was hypothesised that weak pelvic floor muscles could be a cause of erectile dysfunction.

Aims: To compare the efficacy of pelvic floor muscle exercises and manometric biofeedback with lifestyle changes for men with erectile dysfunction.

Design of study: Randomised controlled trial.

Setting: The Somerset Nuffield Hospital, Taunton, United Kingdom.

Method: Fifty-five men with erectile dysfunction (median age 59.2 years; range 22-78 years) were enrolled from a local urology clinic. Of these, 28 participants were randomised to an intervention group and engaged in pelvic floor exercises, as well as receiving biofeedback and suggestions for lifestyle changes. Twenty-seven controls were solely advised on lifestyle changes. Baseline, 3- and 6-month assessments were: erectile function domain of International Index of Erectile Function (IIEF), Partner's International Index of Erectile Function (PIIEF), Erectile Dysfunction-Effect on Quality of Life (ED-EQoL), anal manometry, digital anal measurements, and clinical assessment by an assessor blind to treatment allocation. After 3 months, the control group were transferred to the active arm.

Results: At 3 months, compared with controls, men in the intervention group showed significant mean increases in the erectile function domain of the IIEF (6.74 points, P = 0.004); anal pressure (44.16 cmH(2)O, P <0.001); and digital anal grades (1.5 grades, P <0.001). All showed further improvement in these outcomes at 6 months. Similar benefits were seen in men of the control arm after transfer to active treatment. A total of 22 (40.0%) participants attained normal function, 19 (34.5%) participants had improved erectile function, and 14 (25.5%) participants failed to improve.

Conclusion: Pelvic floor muscle exercises and biofeedback are an effective treatment for men with erectile dysfunction.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Biofeedback, Psychology / physiology*
  • Erectile Dysfunction / rehabilitation*
  • Exercise Therapy / methods*
  • Humans
  • Male
  • Manometry / methods
  • Middle Aged
  • Pelvic Floor / physiology*
  • Piperazines / therapeutic use
  • Purines
  • Quality of Life
  • Sildenafil Citrate
  • Sulfones
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use


  • Piperazines
  • Purines
  • Sulfones
  • Vasodilator Agents
  • Sildenafil Citrate