Erectile dysfunction (ED) is one of the most common disorders among men, which can be secondary to factors such as obesity, diabetes and etc. In this case series study, the effect of friction massage with pelvic floor exercises on erectile dysfunction was investigated in three patients secondary to Prostatic Adenectomy, aging and diabetes

The patients performed the pelvic floor exercises and techniques for one month, and the technique was checked with the patient twice a week by video call. The duration of exercises was 10 minutes and the duration of massage was 10 minutes per day. IIEF15 (International index of erectile function 15) questionnaire and EHS (Erection hardness score) were used to measure the recovery rate. Also, simple ultrasound and color ultrasound was used to check the sonographic factors.

After treatment, in all three patients the EHS index and the IIEF15 index increased. Also with different proportions, the thickness of the ischiocavernosus and bulbospongisios muscles increased, the maximum systolic velocity and minimum diastolic velocity of the cavernosal artery increased but the maximum blood flow velocity in the posterior vein decreased.

Based on the data, the greatest effect of the treatment was observed on the Adenectomy patient, then the elderly patient and finally the diabetic patient. Friction massage technique along with pelvic floor exercises improves the indicators related to erection and increases patient’s satisfaction.

At the end of the 4-week program, significant changes in the sexual ability of the patients were observed, and the observation of these changes shows the effectiveness of pelvic floor muscle exercises along with friction massage in improving erectile dysfunction caused by prostate surgery, diabetes, or aging in these patients. According to the evidence of previous studies, training of pelvic floor exercises and manual therapy has no side effects, and it is easily possible to perform and learn pelvic floor muscle exercises with the help of a therapist. Also, pelvic floor muscle exercises are affordable and can be performed anywhere even during other activities.

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