Pelvic-Floor Muscle Rehabilitation in Erectile Dysfunction and Premature Ejaculation Pierre Lavoisier, Pascal Roy, Emmanuelle Dantony, Antoine Watrelot, Jean Ruggeri, Se ´bastien Dumoulin Background. In men, involuntary or voluntary ischiocavernosus muscle contrac- tions after erection lead to intracavernous blood pressures far higher than the systolic pressure, which builds and maintains penile rigidity. Thus, erectile dysfunction may be partly due to ischiocavernosus muscle atrophy and treated by rehabilitation interventions. Objective. The purpose of this study was to determine whether pelvic-floor muscle strengthening interventions could be associated with increases in intracav- ernous pressure that would increase penile rigidity. Design. An observational study was conducted. Methods. One hundred twenty-two men with isolated erectile dysfunction and 108 men with isolated premature ejaculation participated (no neuromuscular dis- eases or previous perineal rehabilitation). Thirty-minute sessions of voluntary con- tractions coupled with electrical stimulation were designed to increase ischiocaver- nosus muscle strength (monitored through intracavernous pressure increase). A linear mixed-effects model per group analyzed separately, then jointly, the maximum P and the maximum baseline (ie, respectively, the average contraction-generated difference in intracavernous pressure and the intracavernous pressure plateau at full erection, both measured during the highest moving average of the best 2 minutes of each session). Results. Over 20 sessions, the maximum P increased in erectile dysfunction as well as in premature ejaculation (87% and 88%, respectively, in men with positive trends). The maximum baseline also increased (99% and 72%, respectively, in men with positive trends). The joint modeling indicated that the mean expected progres- sions of the intracavernous pressure after 5 sessions in erectile dysfunction and premature ejaculation were 62.85 and 64.15 cm H 2 O, respectively. Limitations. Indirect measurements were obtained of intracavernous pressure and ischiocavernosus muscle force. Conclusions. Pelvic-floor muscle rehabilitation was found to be beneficial in ED. However, its effects on PE symptoms, despite intracavernous pressure gains, were much more difficult to assess. The definitive proofs of its benefits require rather difficult-to-design clinical trials. P. Lavoisier, PT, MD, Centre d’Etudes des Dysfonctions Sex- uelles (CEDS), 153 Rue Pierre Cor- neille 69003, Lyon, France. Address all correspondence to Dr Lavoisier at: pierrelavoisier@ wanadoo.fr. P. Roy, MD, PhD, Hospices Civils de Lyon, Service de Biostatistique; Universite ´ Lyon 1, F-69100, Vil- leurbanne, France; and CNRS UMR 5558, Laboratoire de Biome ´- trie et Biologie Evolutive, Equipe Bio Statistique Sante ´, Pierre- Be ´nite, F-69310, Lyon, France. E. Dantony, MSc, Hospices Civils de Lyon, Service de Biostatistique; Universite ´ Lyon 1, F-69100, Vil- leurbanne, France; and CNRS UMR 5558, Laboratoire de Biome ´- trie et Biologie Evolutive, Equipe Bio Statistique Sante ´, Pierre- Be ´nite, F-69310, Lyon, France. A. Watrelot, MD, Centre de Recherche et d’Etudes de la Ste ´ri- lite ´ (CRES), F-69008, Lyon, France. J. Ruggeri, MD, Centre d’Etudes des Dysfonctions Sexuelles (CEDS). S. Dumoulin, MSc, Centre d’Etudes des Dysfonctions Sex- uelles (CEDS). [Lavoisier P, Roy P, Dantony E, et al. Pelvic-floor muscle rehabili- tation in erectile dysfunction and premature ejaculation. Phys Ther. 2014;94:xxx–xxx.] © 2014 American Physical Therapy Association Published Ahead of Print: xxxx Accepted: July 19, 2014 Submitted: August 2, 2013 Research Report Post a Rapid Response to this article at: ptjournal.apta.org December 2014 Volume 94 Number 12 Physical Therapy f 1 Bio rich3/zad-apta/zad-apta/zad01214/zad3561d14g meadel S=5 8/6/14 13:43 Art: 2013-0354