Written By: Dr. Taylor Kobliska, PT, DPT
Erectile dysfunction (ED) is a common condition that affects millions of men, but it’s not just about sexual performance, it’s a window into overall health and wellbeing. Many people are surprised to learn that the pelvic floor plays a direct role in erectile function, and that pelvic physical therapy can be a valuable tool in treatment. Here are five key facts everyone should know about erectile dysfunction:
1. Pain in the lower back is associated with erectile dysfunction.
The pelvic floor, spine, and hips are closely interconnected. When low back pain is present, it can interfere with the nerves, muscles, and circulation needed for sexual function. Addressing musculoskeletal health, including back, hip, and pelvic mechanics, is often an important step in restoring erectile function (Sahin et al., 2025). Some men report only being able to maintain an erection in certain positions (sitting, standing, laying on your back, etc.). If this sounds like you, musculoskeletal factors and spinal positioning may be impacting your erection and you should let your therapist know!
2. Weak pelvic floor muscles can diminish erection quality.
The pelvic floor muscles, particularly the bulbocavernosus and ischiocavernosus, play an essential role in maintaining penile rigidity. Research shows that men with weaker pelvic floor strength report more difficulty with erectile function (Kim et al., 2021). Strengthening these muscles through guided pelvic floor therapy can significantly improve erection quality and sexual performance (Dorey et al., 2004).
3. Overly tight pelvic floor muscles can also cause problems.
It’s not just about weakness! Excessive tension in the pelvic floor can restrict blood flow and create pain. Overactive pelvic floor muscles may interfere with arousal and contribute to erectile dysfunction but restricting proper blood flow. Effective therapy includes not only functional strengthening, but also learning to relax and coordinate these muscles (Sahin et al., 2025) to improve penile rigidity. Your therapist may use hands-on techniques such as cupping, scraping, myofascial release, and dry needling.
4. Erectile dysfunction and cardiovascular disease are very closely linked.
ED is more than a sexual health issue, it’s often one of the first signs of vascular disease. Large cohort studies have shown that men with ED are at significantly higher risk of cardiovascular events such as heart attack and stroke (Thompson et al., 2005; Jackson et al., 2013). The opposite is also true. Men with already existing cardiovascular concerns like high cholesterol or high blood pressure are at greater risk of developing erectile dysfunction. Because healthy erections depend on healthy blood vessels, ED should always prompt a discussion with a healthcare provider about cardiovascular health.
5. Pelvic floor physical therapy is an evidence-based treatment for ED.
Pelvic floor rehabilitation, including strengthening, relaxation training, and biofeedback, have been shown in randomized controlled trials to significantly improve erectile function (Dorey et al., 2004). More recent reviews confirm that pelvic physical therapy is a safe, effective, and empowering approach that addresses the muscular and biomechanical factors underlying ED (Sahin et al., 2025). If you are dealing with erection quality concerns, please don’t be shy to bring up these concerns with your therapist! We want to help.
The Bottom Line
Erectile dysfunction is multifactorial, sometimes caused by cardiovascular issues, sometimes linked to back pain or pelvic floor dysfunction, and often a combination of other factors we haven’t fully discussed here. The good news is that help is available. If you’re experiencing ED, talk with your healthcare provider and pelvic floor physical therapist. If you do not already have a pelvic floor physical therapist, give us a call at (801) 702-8475 to get scheduled. Addressing the pelvic floor not only supports sexual function but also promotes long-term pelvic and cardiovascular wellness. We are here for whole body wellness!
References
- Dorey, G., Speakman, M., Feneley, R., Swinkels, A., Dunn, C., & Ewings, P. (2004). Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. British Journal of General Practice, 54(508), 819–825.
- Jackson, G., et al. (2013). Erectile dysfunction and cardiovascular disease: An evidence-based link. European Heart Journal, 34(27), 2034–2046.
- Kim, J. K., et al. (2021). Pelvic floor muscle strength is associated with erectile function: A prospectively collected observational study. Scientific Reports, 11, 11214.
- Sahin, E., et al. (2025). Pelvic physical therapy for male sexual disorders: A narrative review. Sexual Medicine Reviews, 13(1), 85–96.
- Thompson, I. M., Tangen, C. M., Goodman, P. J., Probstfield, J. L., Moinpour, C. M., & Coltman, C. A. (2005). Erectile dysfunction and subsequent cardiovascular disease. JAMA, 294(23), 2996–3002.