Pilates Could Be a Low-Impact Investment With High-Impact Returns
While medications can provide temporary respite from erectile dysfunction (ED) symptoms, some experts say Pilates may offer a long-term solution.
ED, a consistent inability to achieve and maintain an erection firm enough for intercourse, is a common disorder that can substantially impact a person's mental and physical well-being.
This dysfunction is most prevalent in older men—younger men are not immune, though—in part because muscle tone and strength can diminish with age and certain related conditions are more common in older adults.
Studies indicate that regular exercise, including Pilates and specific exercises that target the pelvic floor muscles, can provide a boost to erectile function.
The various causes of ED
ED can affect people of all ages, and its causes can be physical, psychological or both.
"Broadly speaking, the most common causes of erectile dysfunction are hormonal issues, abnormal or inadequate inflow or trapping of blood, psychological factors and neurological deficits," said Joshua Gonzalez, M.D., a Los Angeles-based urologist and a sexual health advisor at Astroglide, a lubricant manufacturer.
Physical health factors that can cause ED include cardiovascular disease, decreased aerobic fitness, smoking, alcohol use, diabetes, and high levels of cholesterol, blood sugar or triglycerides, according to Brynna Connor, M.D., a family medicine practitioner in Austin, Texas.
Psychological factors that can lead to ED include depression, guilt, poor body image, concern about weight gain, stress, relationship issues, sleep disorders and performance anxiety, she said.
Medical conditions such as chronic kidney disease, multiple sclerosis and Peyronie's disease, and injuries to the pelvis, penis, prostate gland, bladder or spinal cord, can increase a person's risk of erectile dysfunction, as can some medications, including antidepressants, high blood pressure medicines, antiandrogens and prescription sedatives, may contribute to sexual dysfunction.
The ED-exercise connection
Generally, anything that improves your overall health can also enhance your sex life, and this includes exercise.
"Exercise decreases ED, as it improves oxygenation to all tissue and organs, and the male genital organs are no exceptions," Connor said.
A 2018 study published in Sexual Medicine found that 40 minutes of aerobic exercise a day, four times a week for six months, was sufficient to improve sexual function in people who had ED caused by lack of exercise, obesity, hypertension, cardiovascular disease or metabolic syndrome.
"Exercise is good for cardiovascular health, which in turn is good for erectile health," Gonzalez said. "The penis is a vascular organ and requires a healthy cardiovascular system to achieve and maintain rigidity. So regular exercise can keep your penis and your erections in tip-top shape."
In addition to boosting cardiovascular fitness, regular exercise may assuage ED symptoms by improving mental health.
Any physical activity, including walking, cycling and swimming, can help. Studies indicate exercises targeting the pelvic floor muscles, including Pilates and Kegels, may have added benefits.
In a clinical trial published in 2005 in BJU International, men with ED were treated with pelvic floor muscle exercises with biofeedback and lifestyle changes, or lifestyle changes only. Researchers found men engaged in pelvic floor strengthening improved significantly compared to those treated with lifestyle changes alone. After six months, 40 percent of men who received the intervention had regained complete erectile function, while 35.5 percent had shown improved function.
How Pilates works for ED
Pilates strengthens the pelvic floor, which is very important for preventing or treating ED, Connor said.
"Pilates helps keep blood in the penis—enhancing erections and preventing dysfunction—and this increases the rigidity of the penis during sexual activity," she said.
Pain and injury can impede function in certain stabilizing muscles, and Pilates can help restore it, said Lyndsay Hirst, a physiotherapist, the clinical director at Leeds Physiotherapy and Pilates Practice, and the owner of Your Pilates Physio in the United Kingdom. Hirst practices clinical Pilates, which differs from its traditional counterpart in that it applies physiotherapy principles and tailors exercise programs to clients' specific conditions and needs.
"We train the muscles to be active and remain active during movement. The brain starts to understand the function of the muscles again, so they become more active during normal activity," she said. "Patients with ED often have a reduced awareness as to where their joints are. Proprioception is the brain's ability to understand where the joints are in space. This, coupled with reduced activity in the stabilizing muscles—think of these as the tiny muscles that support the joint as it moves—makes the joint vulnerable to injury. Pilates works to improve both proprioception and the strength and control of these stabilizing muscles."
Some examples of moves a clinical Pilates instructor might suggest to strengthen pelvic floor muscles include:
- Pelvic curl, or "bridge pose"
- Pelvic tilt
- Pelvic rock
- Zip and hollow
- Knee fallouts
- Supine foot raises
How to do Pilates safely
Although Pilates can benefit many men with erectile dysfunction, it isn't a one-size-fits-all solution. For this reason, it's best to consult a physiotherapist and a urologist before cueing up a YouTube workout.
Gonzalez said the relationship between the pelvic floor and erections is complicated. Some people's pelvic floor muscles are too tight, impinging blood vessels and nerves and negatively impacting erections. Some people have a weak pelvic floor and can have trouble maintaining their erections. Pelvic floor exercises, usually under the guidance of a trained pelvic floor physical therapist, can be helpful to correct these issues, he said.
Pilates can be either helpful or detrimental to erections, depending on the particular practice or exercises being performed, Gonzalez said. Pilates exercises that focus on increasing core strength and, by extension, increasing tension in the surrounding pelvic muscles can be bad for someone who is already too tight. However, Pilates exercises that focus on opening up, stretching, elongating, and increasing blood flow to the pelvis may be helpful in some cases.
'Pilates helps keep blood in the penis—enhancing erections and preventing dysfunction—and this increases the rigidity of the penis during sexual activity.'
Gonzalez also advises people with chronic pelvic pain syndrome (CPPS) to be cautious with Pilates moves that emphasize core strengthening, which could exacerbate muscle tension and erectile dysfunction, and increase pelvic pain.
"That doesn't mean they can never engage in those exercises, but they should probably work with a pelvic floor PT first and gradually work up to a more core-strenuous Pilates routine," he said.
If you and your healthcare providers determine Pilates is suitable for you, it will take some time to see an improvement, according to Gonzalez and Hirst. Likewise, to maintain results, most people will need to continue practicing regularly in the long term.
"Pilates, like most exercise routines, takes time, practice and patience to realize change," Gonzalez said. "If someone is using Pilates to help improve their erections, it may take some time. As with most exercise routines, give it three to six months to really notice a difference."