Over the last few years, a growing body of studies has expanded our understanding of male pelvic floor dysfunction and refined the approach to treatment within pelvic rehabilitation. The latest evidence supports a multifaceted, neuro-muscular strategy grounded in early intervention, individualized care, and integration of tools like electrical stimulation and manual therapy. Below, are a few key findings that are reshaping clinical protocols and outcomes in male pelvic rehab.

Post-Prostatectomy Urinary Incontinence
Pelvic floor muscle training (PFMT) remains the first-line therapy for post-prostatectomy incontinence (PPI). A 2022 meta-analysis by Park et al, involving 21 randomized controlled trials, found that PFMT nearly tripled continence rates compared to no PFMT. Patients also showed significant improvements in both objective measures (e.g., pad counts) and subjective continence scores.

While long-term benefits are well established, recent research emphasizes the importance of early initiation. Multiple studies support beginning PFMT preoperatively or immediately postoperatively to optimize outcomes, particularly after nerve-sparing robotic-assisted radical prostatectomy. Timed, progressive PFMT, especially when started early, is essential for maximizing continence recovery, even more so in cases involving nerve-sparing approaches that may affect pelvic floor coordination.

Combining PFMT with Electrical Stimulation
A 2025 meta-analysis by Lunardi et al examined 885 female patients and found that pelvic floor muscle training (PFMT) combined with electrical stimulation significantly outperformed PFMT alone in improving continence, pelvic floor strength, and quality of life. However, these findings are limited to women and do not directly translate to male populations.

In contrast, evidence in male patients, particularly those with post-prostatectomy incontinence, is more mixed. A randomized, placebo-controlled trial by Yamanishi et al. in 2010 that involved 56 men found that PFMT combined with anal electrical stimulation significantly improved continence rates during the early recovery period (1–6 months) compared to “sham” stimulation. However, by 12 months, the difference between groups was no longer statistically significant, suggesting that the benefits may be short-term.

While adjunctive electrical stimulation appears to provide early benefit in some men, especially those with severe leakage or poor initial voluntary contraction, the long-term advantage remains uncertain. Patients with limited neuromuscular control may benefit from neuromuscular electrical stimulation (NMES) to enhance recruitment and early adherence, but expectations should be managed regarding sustained continence outcomes beyond the first 6–12 months.

Pelvic Floor Therapy for Sexual Dysfunction
Emerging literature from Pastore et al. (2021) supports pelvic rehab in the management of erectile dysfunction, premature ejaculation, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Integration of manual therapy, PFMT, and behavioral retraining has yielded meaningful gains in function and reduction in nociceptive signaling.

A 2024 study utilizing High-Intensity Focused Electromagnetic (HIFEM) therapy further points to new frontiers in non-invasive intervention for erectile dysfunction and male urinary control.

These findings highlight the evolving role of pelvic floor therapy as a cornerstone in the multidisciplinary management of male sexual dysfunction. Whether through traditional rehabilitation approaches—such as PFMT, manual therapy, and behavioral retraining—or through emerging technologies like HIFEM, pelvic health interventions demonstrate tangible benefits in improving sexual function, alleviating pelvic pain, and restoring urinary control.

Clinical Patterns Worth Noting
In clinical practice, several common patterns emerge when treating male pelvic floor dysfunction. Patients with chronic pelvic pain frequently present with pelvic floor overactivity, often accompanied by restrictions in the obturator internus, adductor magnus, and piriformis muscles. This hypertonicity is commonly associated with neural sensitization and can be exacerbated by postural imbalances or stress-related bracing strategies.

Men recovering from prostatectomy may exhibit compensatory recruitment of accessory muscles, such as the gluteal and abdominal muscles, due to impaired pelvic floor motor control. This can reduce the effectiveness of voluntary pelvic floor muscle contractions and contribute to persistent urinary leakage despite exercise adherence. Thorough neuromuscular re-education is often required to facilitate isolated pelvic floor activation and restore continence.

Erectile dysfunction in this population is frequently compounded by contributing factors such as pelvic asymmetry, altered respiratory diaphragm coordination, and increased thoracolumbar tension. These findings emphasize the importance of a whole-body biomechanical and neuro-myofascial assessment, as pelvic floor dysfunction in men rarely presents in isolation. Recognizing and addressing these interrelated impairments is key to achieving lasting functional outcomes.

August Satellite Lab: Pelvic Function Level 2C
Herman & Wallace invites you to refine your clinical reasoning and hands-on skills at the upcoming Pelvic Function Level 2C Satellite Lab Course, held August 16–17.

This intermediate-level course emphasizes:

• Recognizing the key signs and symptoms that lead to impairment, functional limitations, and disabilities in men’s health
• Use of an evaluation/outcome tool relating to patient condition(s)
• Designing a multi-modal plan of care for pelvic rehabilitation
• Performing clinical interventions based on the patient's presentation and goals

Clinical treatment interventions include patient education, neuro re-education, therapeutic exercise, manual therapy, therapeutic activities, instruction in self-care, and recommendations for relevant modalities.

It’s essential that pelvic rehabilitation continues to evolve beyond the historically female-centered framework to address the full spectrum of pelvic dysfunction, including the complex needs of male patients. Evidence indicates that targeted, neuromuscular-driven rehabilitation strategies can significantly improve outcomes for men experiencing urinary, sexual, and pain-related pelvic conditions.

The August course is available in 9 different satellite locations as well as self-hosted. Satellite locations for Pelvic Function Level 2C: Men’s Pelvic Health and Rehabilitation include:

• Columbus OH
• Danvers MA
• Katy TX
• Milwaukee WI
• New Orleans LA
• New York NY
• Palm Beach FL
• Paso Robles CA
• Tacoma WA
• Self-Hosted

References

1. Park JJ, Kwon A, Park JY, Shim SR, Kim JH. Efficacy of Pelvic Floor Exercise for Post-prostatectomy Incontinence: Systematic Review and Meta-analysis. 2022 Oct;168:175-182. doi: 10.1016/j.urology.2022.04.023. Epub 2022 May 5. PMID: 35526757. https://pubmed.ncbi.nlm.nih.gov/35526757/
2. Lunardi AC, Foltran GC, Carro DF, Silveira LTY, Haddad JM, Ferreira EAG. Efficacy of electrical stimulation in comparison to active training of pelvic floor muscles on stress urinary incontinence symptoms in women: a systematic review with meta-analysis. Disabil Rehabil. 2025 Jun;47(13):3256-3267. doi: 10.1080/09638288.2024.2419424. Epub 2024 Oct 28. PMID: 39467254. https://pubmed.ncbi.nlm.nih.gov/39467254/
3. Yamanishi T, Mizuno T, Watanabe M, Honda M, Yoshida K. Randomized, placebo-controlled study of electrical stimulation with pelvic floor muscle training for severe urinary incontinence after radical prostatectomy. J Urol. 2010 Nov;184(5):2007-12. doi: 10.1016/j.juro.2010.06.103. Epub 2010 Sep 20. PMID: 20850831. https://pubmed.ncbi.nlm.nih.gov/20850831/
4. Pastore AL, Palleschi G, Fuschi A, Maggioni C, Rago R, Zucchi A, Costantini E, Carbone A. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. Ther Adv Urol. 2014 Jun;6(3):83-8. doi: 10.1177/1756287214523329. PMID: 24883105; PMCID: PMC4003840. https://pmc.ncbi.nlm.nih.gov/articles/PMC4003840/
5. Yaacov D, Nelinger G, Kalichman L. The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review. Sex Med Rev. 2022 Jan;10(1):162-167. doi: 10.1016/j.sxmr.2021.02.001. Epub 2021 Apr 27. PMID: 33931383. https://pubmed.ncbi.nlm.nih.gov/33931383/
6. Brandeis J. Improving Male Pelvic Health: Efficacy of HIFEM Muscle Stimulation for Urinary Function and Sexual Dysfunction in Men. Reproductive System & Sexual Disorders: Current Research. Research Article. 2024; 13(1). ISSN: 2161-038X. https://www.longdom.org/open-access/improving-male-pelvic-health-efficacy-of-hifem-muscle-stimulation-for-urinary-function-and-sexual-dysfunction-in-men-106497.html