Case Study: Pelvic Floor Exercises vs ED Pills

This article compares pelvic floor muscle training (PFMT) against phosphodiesterase-5 inhibitors (PDE5 inhibitors, “ED pills”) using human trial data and guidelines. It focuses on outcomes measured by validated tools such as the International Index of Erectile Function (IIEF).

Why compare these options

• PFMT targets the bulbocavernosus and ischiocavernosus muscles involved in penile rigidity and venous occlusion.
• PDE5 inhibitors enhance nitric-oxide mediated vasodilation for erection on sexual stimulation.
• Patients should be informed of all reasonable options and choose based on goals, comorbidities, and preferences (AUA guideline; Journal of Urology version).

Pelvic floor training: what trials show

Randomized controlled trial

• Dorey et al., 2004 RCT: PFMT with biofeedback improved erectile function versus controls in men with ED.
• Follow-up publications and abstracts report restoration of erectile function in a substantial subset after structured training (BJU International 2005; Europe PMC abstract).

Systematic reviews

• Wong et al., 2020: most included studies showed PFMT improves ED, but methods and protocols vary, limiting precision of effect size.
• Additional overviews support PFMT as a conservative option that can improve erectile and ejaculatory parameters, including post-prostatectomy settings (network review context; Lavoisier 2014 review).

Timeframe and adherence

• Typical programs: daily contractions with progressive load and biofeedback, reassessed over 8 to 12 weeks.
• Results depend on technique, supervision, and consistency.

ED pills: what trials show

Effectiveness

• Sildenafil meta-analysis: global improvement NNT ≈ 1.7; about 49% of men achieved at least 60% successful intercourse attempts with dose-optimized sildenafil versus 11% with placebo.
• Tadalafil vs sildenafil: similar IIEF-EF improvements on average across head-to-head data.

Adverse effects

• Common events include headache, flushing, dyspepsia, nasal congestion; treatment-related events in about 30% on dose-optimized sildenafil vs 11% on placebo in pooled trials (meta-analysis).
• Contraindicated with nitrates; caution with certain cardiovascular conditions per guidelines (AUA).

Direct comparison: where each fits

• Speed: PDE5 inhibitors act on demand. PFMT requires weeks of training before measurable gains are seen.
• Durability: PFMT may produce lasting improvements in baseline function if muscles strengthen and coordination improves. Pills provide effect per use.
• Side effects: PFMT is low risk when properly taught. Pills have predictable pharmacologic side effects and drug interaction cautions.
• Combinations: Exercise and lifestyle measures can enhance erectile function and may complement PDE5 responses in selected patients (AUA PDF).

Who might consider PFMT first

• Men preferring conservative, drug-free approaches or who cannot use PDE5 inhibitors.
• Men with pelvic floor weakness or mixed sexual dysfunction where muscular coordination is relevant.
• Men interested in pairing PFMT with cardiovascular exercise and weight management to address vascular contributors.

Practical PFMT starting points

• Seek instruction from a pelvic health physiotherapist for correct muscle isolation and progression.
• Use a structured program with daily sessions for at least 8 to 12 weeks, adding biofeedback if available (Dorey RCT).
• Track outcomes using IIEF or a simpler symptom diary to quantify change.

Key limitations to keep in mind

• PFMT trials often have small samples and heterogeneous protocols, limiting pooled effect estimates (systematic review).
• Placebo responses in ED research are notable; careful interpretation of any single study is needed (JAMA Network Open 2020).

Where Erectimus fits

• Read how the formulation supports circulation and performance: How Erectimus Works.
• Ingredient background and evidence overview: Maca Root for Men’s Performance.
• Try a starter option: Erectimus Single Pack.

Bottom line

• PDE5 inhibitors deliver fast, on-demand efficacy with known side effects and interactions supported by large RCTs and meta-analyses.
• PFMT can improve erectile function with minimal risk, but requires supervised technique and consistent training over weeks.
• Choice depends on medical eligibility, speed of desired results, and preference. Combining PFMT with lifestyle measures can support outcomes, with or without medication.

Selected references

• Dorey G. Randomised controlled trial of PFMT with biofeedback for ED (2004).
• BJU International report on PFMT for ED (2005).
• Wong C. Systematic review of PFMT for ED (2020).
• Moore RA. Sildenafil meta-analysis with NNT estimates (2002).
• Gong B. Tadalafil vs sildenafil meta-analysis (2017).
• American Urological Association ED Guideline (2018).