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originally published: January, 2016

birmingham health physiotherapy
Prostate Surgery, Erectile Dysfunction and Physiotherapy

Prostate Surgery, Erectile Dysfunction and Physiotherapy and how might it relate to you?


Prostate cancer is very common with an estimated incidence of 1 in 8 in the UK. Older men, those with a family history and Black men are more at risk. What are the risk factors, check out this great infomatic from Prostate Cancer UK www.prostatecanceruk.org



Initially the most important decisions will be made between you and your doctor or specialist nurse as to the best treatment of choice for you. A great resource on prostate cancer is provided by Prostate Cancer UK


Following your surgery or treatment there will be great relief that the cancer has been treated or removed . Moving forwards, for you and if your are in a relationship, your partner can face difficult times as you may have to face some of the possible complications and side affects of treatment.

Sex Life
It’s common for men and their partners to worry about whether they will be able to return to an active sex life. For us men SEX is important, whether in a relationship or not. The ability to get and maintain an erection is important to us and can define us. It is also one thing that we would rarely talk to our closest friends about if we “couldn’t get it up”. Prostate cancer can affect sex as erectile dysfunction is common and it may be difficult to both get and maintain an erection. Regardless of age, sexual orientation or being in a relationship or not this is important to us. Some other treatments such as radiation or  hormone therapy may lead to pelvic pain which can limit your sexual activity and the whole cancer episode can lead to a loss of libido.

Some good stuff from Australia on how cancer affects your sex life

For your  partner this can be difficult also as they may feel you  becoming more distant, less tactile and less interested in them. Commonly post prostate surgery you may develop urinary incontinence and having to wear pads and worrying about leaking tends to kill many urges to have sex.

Is sex important post surgery?
The overwhelming relief post surgery or treatment is that the cancer is gone or being treated. However, later on resuming an active sex life may be important and as mentioned before for men the ability to get an erection is important. Erectile dysfunction is common especially with increasing age, obesity, hypertension, heart disease , diabetes and poor levels of fitness so what’s the big deal. The big deal for many men with prostate cancer is that pre diagnosis they had nor problems south of the border so the change from fully alert and ready to flaccid can be a dramatic one.



What has this got to do with Physiotherapy?
A good erection needs strong muscles, these are your pelvic floor muscles and yes men have them too. They help you get an erection , maintain it and ejaculate. Like any muscle ( think Calf muscles) if they have become weak or damaged from the surgery and this is common they can be strengthened. They also have to work harder after the surgery once the prostate is removed. The prostate helps your urine control and once it has been removed (one type of surgery) the pelvic muscles have to work harder to compensate for this. Think of it like a sports injury , If Leonel Messi tears his cruciate ligament ( prostate ) then he will have to work very very hard on his Quadriceps muscles ( Pelvic floor ) to compensate. Otherwise his knee ( erection ) won’t work very well. As he trains his quads (pelvic floor) his performance will improve ! You may not win the Ballon Dor but the option to use it again will be there.

FOOT - FIFA BALLON D'OR 2012 - 2013messi (lionel)

FOOT – FIFA BALLON D’OR 2012 – 2013 messi (lionel) EXCLU FRANCE FOOT

A good erection (is there ever a bad one!) also needs a lot of blood supply. The blood supply can be affected by the surgery or other treatment and all muscles need good blood supply to work. The first sign of heart disease can be erectile dysfunction but it tends not to be picked up very early as men rarely tell anyone about their problems down there . Severe crippling chest pain tends to focus the mind though!  The last thing a good erection needs is a good nerve supply and due to surgical advances a lot of procedures now are nerve sparing .  However, a big nerve called the pudendal nerve can be affected. This is very common in cyclists as they sit on it all day so the next time you meet some of your lycra chums ask them can then get it up after 6 hours on the bike, the answer may surprise you. A calm relaxed mind also helps and this is challenging post cancer due to the worry, anxiety , stress it causes. What helps blood supply and decreases stress and anxiety, you’ve guessed it EXERCISE. When things improve Sex can also be part of that exercise regime.

How Can Physiotherapy help?
A lot, there is really good published research that specialist men’s health physiotherapy can help with erectile dysfunction post prostate surgery.


Don’t feel you need to read all of the above but the summary is important.  “Pelvic floor exercises are effective for erectile dysfunction”.

We are also happy for your partner to attend to meet us if you want as they will also  have questions they want answered also.

 What might Specialist Men’s Health Physiotherapy involve?

US pelvic floor


  1. Pelvic Floor rehabilitation using ultrasound imaging technology. We will look at them on an Ultra Sound Think pregnancy scans. It’s not just a case of tighten down there but quite a specialised progressive programme involving different types of Pelvic Floor muscles ( Usain Bolt sprint Pelvic floor muscles and Mo Farah long distance Pelvic Floor muscles ) , abdominals and other big hip muscles.
  1. Pelvic floor +: this is getting you to work your pelvic floor during normal exercises and activities. This is more fun.
  2. Exercise to relax and allow you to switch the volume down a bit in your head, yoga , meditation or what you enjoy doing. Our Men’s Health Physio clinic is based at the Barefoot Yoga studio in Harborne and all our patients and clients comment on how tranquil, relaxing and very non clinical it is. 

    Graduated exercise programme as we know exercise helps with blood flow, stress and strengthening and you’ll feel better doing something.
    Manual therapy/ Acupuncture ( not in there though) if you have any pelvic or back pain that is affecting things.
    Clinical psychology ( if needed) as we are one of the few Men’s Health clinics to work with a clinical psychologist who you may feel like meeting or your and your partner . Dr Richard Bennett our friend and colleague has considerable experience at this also

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