The pelvic floor muscles surround the lower corpora cavernosa, the two cylinders of spongy tissue that, when engorged with blood, cause an erection. The amount of pressure (hardness) of these tissues depends on inflow of arterial blood, maximized by NO, and outflow of blood through the veins carrying blood away from the penis. As the pelvic floor muscles lose their tone (lack of physical exercise can do this), they fail to close off the venous outflow of blood that maintains the erection. As these muscles become stronger and bulkier with general exercise or specific pelvic floor exercises (PFEs), outflow of blood is reduced. PFEs have been evaluated in a scientific study. The men who performed PFEs had a significant increase of their erectile function scores, while the men who did not remained unchanged. When the men who were not performing the PFEs then began to do them they had a similar improvement in the ED. When the study results were compared with the use of prescription medication, Viagra for severe ED, the results were remarkably similar. Viagra increases arterial inflow, while PFE decrease venous outflow and increase pressure and therefore penile rigidity. It makes sense that these two approaches should be combined, because individual men may respond to one approach better than to the other. Increasing arterial inflow while simultaneously decreasing venous outflow and increasing pressure within the penis should be the ideal approach for all men with ED. How to Perform Pelvic Floor Exercises (PFEs) for ED In standing position, stand with your feet apart and tighten your pelvic floor muscles as if you were trying to stop the flow of urine and intestinal gas from escaping. Looking in a mirror, you should be able to see the base of your penis move nearer to your abdomen and your testicles rise. Hold the contraction as strongly as you can. Try to avoid holding your breath, pulling in your abdomen or tensing your buttocks. Perform 3 maximal contractions while standing in the morning and hold them for 10 seconds. And perform 3 maximal contractions while standing in the evening holding each of them for 10 seconds.

At other times during the day: In the sitting position, sit on a chair with your knees apart and tighten your pelvic floor muscles as if you were lifting your pelvic floor but not your buttocks off the chair. Hold the contraction as long as you can. Try to avoid holding your breath, pulling in your abdomen or tensing your buttocks. Perform 3 to 6 maximal contractions while sitting during the day holding them for 10 seconds each.

As time permits, in the lying position, lie on your back with your knees bent and your knees apart. Tighten your pelvic floor muscles and hold the contraction as long as you can.Try to avoid pulling in your abdomen or tensing your buttocks. Perform 3-6 maximal contractions while in the lying position. Other ways to do PFEs: While walking, try lifting your pelvic floor muscles up 50% of maximum when walking.

After you have voided urine, try tightening your pelvic floor muscles strongly to avoid the after-dribble.

During sexual activity, try tightening your pelvic floor muscles rhythmically to achieve and maintain penile rigidity during sexual activity. Slow thrusting movements generate higher pressures inside the penis (pressure on the tip of the penis causes contractions of those same muscles).

And finally, to delay ejaculation, for men with premature ejaculation, try tightening your pelvic floor muscles to delay ejaculation.