Does massage help erectile dysfunction?
Neither the European nor the American guideline for erectile dysfunction includes massage among its treatments. The options they do recommend range from lifestyle change and PDE5 inhibitor tablets to injections, vacuum devices and implants, and implant surgery reaches 92% to 100% patient satisfaction. Pelvic floor muscle training, a different approach, shows early promise after prostate surgery.
Which treatments do the guidelines recognise for erectile dysfunction?
The European guideline recommends lifestyle change and risk factor control, PDE5 inhibitor tablets as first-line therapy, injections into the penis, alprostadil applied to the penis or the urethra, vacuum devices and, when other treatments fail or by preference, a penile implant. Psychological therapy is recommended alongside medical treatment when it is indicated.
The American guideline sets out the same range and states that every man should be told about all options that are medically safe for him. Massage does not appear in either guideline.
How is pelvic floor muscle training different from massage?
Pelvic floor muscle training is exercise of the muscles at the base of the pelvis, usually taught and supervised, rather than massage of the penis or the surrounding area. Biofeedback uses a sensor so that the man can see when he is contracting the right muscles.
"Findings from a systematic review had suggested that pelvic floor muscle training combined with bio-feedback is a promising alternative to pharmacological treatments, although there is a need for future well-powered, rigorously designed RCTs to draw strong conclusions" Source 1, p. 56
This finding comes from men treated for erectile dysfunction after prostate cancer surgery. Early use of a vacuum device is another non-drug approach studied in this group, with an excellent effect and no serious side effects.
Why does it matter that massage is not listed?
Both guidelines cover non-drug treatments in detail, including vacuum devices, lifestyle change and psychological therapy. They also name newer treatments that are still being studied, such as shockwave therapy, platelet-rich plasma and stem cells, and label them as investigational or limited to trials.
Massage does not appear even in that category, so it has not been assessed as a treatment for erectile dysfunction in either guideline. The European guideline also notes that the market for natural treatments has grown fast with very little reliable evidence of effectiveness or safety.
Which non-drug options do have evidence?
Physical activity, particularly aerobic exercise, weight loss and treatment of heart risk factors may improve sexual function, and the European guideline makes a strong recommendation to start these changes before or alongside other treatment. Vacuum devices suit men who want treatment without medicines.
Explaining how sexual response works is often the first step in treatment and has been shown to improve sexual satisfaction. Cognitive behavioural therapy (CBT), in group or couple format, is recommended, and combining it with medical treatment is regarded as best practice.