Our experienced physiotherapists can offer a full assessment of your problems and formulate an individual treatment plan that could include the following treatment options:
Extracorporeal Shockwave therapy
Extracorporeal Shock Wave Therapy (EWST) works by passing shock waves, an intense but short energy wave that travels faster than the speed of sounds into the tissues.
Shockwave treatment initiates a proflamatory response in the tissue where the shockwaves have been applied. The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes.
In Erectile Dysfunction, shockwave improves erections via two mechanisms:
- Promotes angio-genesis(development of new blood vessels) in the penis which means that the blood flow to the penis increases and hence stronger erections are achieved
- Rejuvenation of penis smooth muscle– the majority of patients suffering from ED do so because the smooth muscle in their penile arteries has been damaged thus inhibiting the functioning of the so-called veno-occlusive mechanism. Shockwave therapy has been shown to induce the body to repair the smooth muscle in the penis and thus improve the function of the veno-occlusive mechanism.
There is a growing body of scientific evidence that shockwave therapy for ED can help in the following ways:
- Patients with mild to moderate ED that respond well to PDE-5 inhibitors might be able to regain their natural erections and no longer need – or reduce their dependence on medication.
- Patients with moderate to severe ED that do not respond to PDE-5 medication and rely on injections or other topical treatments may become more respondent to PDE-5 medication after shockwave therapy.
- Shockwave therapy will in most cases improve the outcomes of any other treatment modality.
What should I expect during my treatment session?
Each treatment session lasts around 20 minutes. When you arrive at the clinic you will be taken to the consultation room with the shockwave machine where you will get undressed and lie on the treatment bed. The medical practitioner will then apply the treatment using a special probe on different parts of your penis and perineum. Most patients experience very little discomfort or pain during the session. It is important that if you do not feel comfortable you let your medical practitioner know and the shockwave intensity will be adjusted accordingly
What is the best Shockwave Therapy treatment protocol?
This is an area of very active research. A number of treatment protocols have been suggested, some lasting only 4 sessions and some as long as 12 sessions. Unfortunately, the clinical trials investigating these protocols are quite different in a number of ways (energy of the shockwaves applied, number of shockwaves, number of sessions, duration of treatment and time between sessions and the technology of the shockwave machines).
Whereas all these trials have proved the treatment benefits, there is no clear protocol that applies to all patients. Studies so far indicate that the there is no one size fits all protocol and the number of sessions will depend on the severity of ED, the presence of comorbidities and the response to treatment. At our clinic as a minimum, we recommend 6 twenty-minute sessions.
Regarding the number of pulses, the range should be between 3000 and 5000 shock waves per session and there is evidence that administering more shock waves leads to greater improvements. It also seems beneficial to deliver treatment to multiple sites to reach the vascular bed of the erection mechanism.
Is the Shockwave Therapy treatment itself painful?
Sometimes the treatment is a bit painful, but most people can stand these few intense minutes without medication. If patients are in pain during the treatment, they are to notify the medical practitioner as there are some adjustments that can be made to reduce the discomfort.
Will there be any pain after the treatment?
Normally patients experience a reduced level of pain or no pain at all immediately after the treatment, but a mild and diffused pain may occur a few hours later. This dull pain can last for a day or so.
What if there is pain experienced after the treatment?
Shockwave therapy treatment initiates a pro-flammatory response in the tissue that is being treated. If necessary, patients may use ordinary prescription-free painkillers. Do not use anti-inflammatory medication or ice in the treated area as both may interfere with the body’s self-healing abilities.
What if the shockwave therapy treatment doesn’t work?
Usually, the response to shockwave therapy treatment is good however it may take several months before the maximum effect is achieved. If after 3-4 months the patient still does not experience a pronounced improvement, then other treatment modalities will need to be considered.
Laser light – a new, non invasive treatment for Erectile Dysfunction. In vitro and animal studies have shown that the application of laser light may induce vasorelaxation, which is the event that produces penile erection.
Therapeutic laser systems provide a simple, pain-free, drug-free, non-invasive treatment option that is free of side effects for a host of nerve, muscle, and joint conditions. Backed by over 4,000 studies worldwide, the safety and efficacy of laser therapy has been proven countless times for hundreds of medical conditions.
The therapeutic laser systems work by exposing tissue to light energy on two wavelengths, triggering a chain of biological reactions on the cellular level that produces increased nitric oxide and initiates blood flow in tissue. As a result, cool laser therapy produces two highly desirable effects that are critical in the treatment of ED.
Like many of the current medications available to manage ED, laser therapy treatments work by opening vascular passages to allow more blood to flow into the penis, and by blocking the PDE5 enzyme, which restricts the flow of blood out of the penis, leading to longer and stronger erections.
Using the 905 nm infrared wavelength, laser deliver billions of photons to tissue in the penis, resulting in the increased production of nitric oxide (NO). The increased NO production acts as a vasodilator, opening up arteries to increase blood flow to the penis leading to an erection.
At the same time, the 660 nm red wavelength increases sensation within the penis. This increased sensation, coupled with the increased blood flow caused by the 905 nm wavelength, makes it easier for men suffering from ED to generate/produce an erection.
Assessment and treatment of chronic pelvic pain syndromes (CPPS)
There are four main types of prostatitis:
- chronic pelvic pain syndrome (CPPS)
- acute bacterial prostatitis
- chronic bacterial prostatitis
- asymptomatic inflammatory prostatitis.
CPPS is the most common type of prostatitis – around 19 out of every 20 men (90 to 95 per cent) with prostatitis have it. Men with CPPS usually have symptoms for three months or longer. Even after treatment, you may still have prostatitis for a long time. It might come and go, causing occasional episodes of severe pain, sometimes known as flare-ups. Nobody knows for certain what causes CPPS. Unlike other types of prostatitis, it isn’t usually caused by a bacterial infection. There could be a number of causes, which makes it difficult to diagnose and treat.
Millions of men worldwide suffer from pelvic pain, discomfort or dysfunction. In the majority of cases doctors can find little or no physical basis for the symptoms. This syndrome often includes pain and dysfunction relating to urination, defecation and sexual activity. Men also experience anxiety or depression.
CPPS is associated with overuse of the human instinct to protect the genitals, rectum and contents of the pelvis from injury or pain by contracting the pelvic muscles. This tendency becomes exaggerated in predisposed individuals, and in time results in chronic pain and dysfunction. The state of chronic constriction creates pain referring trigger points, reduced blood flow and an inhospitable environment for the nerves blood vessels and structures throughout the pelvic region.
Trigger point release.
A trigger point is a sensitive area in the muscle or connective tissue (fascia) that becomes painful when compressed. Pressing on a trigger point can cause referred pain and can help identify the external area in the body generating the pain. These trigger points can be found locally in the pelvic floor, but also in the abdomen, low back, buttocks and groin area. Treating these trigger points can be manual or involve trigger point acupuncture.
This is the practice of allowing the pelvic floor muscles to drop and relax all day. This system teaches you to be aware of your pelvic floor muscles and how to relax them throughout the day
Lumbar spine evaluation
The lumbar spine can refer pain to the genital area, and examination and treatment of the spine with mobilising techniques, acupuncture or electrotherapy can be indicated.
Muscle stretching, release and strengthening techniques can be employed
The usual problem in the pelvic floor is increased tension (but not necessarily strength). Biofeedback can be used to reduce this resting tension.
Increasing Blood flow
Constriction of the blood flow to the genital area by the tight muscles can result in increase in pain. This can be treated with electrical treatments such as shockwave or laser
Although the muscles are generally in a state of tension, paradoxically they are often very weak.
Muscles strengthening techniques include graded pelvic floor exercises, and muscle stimulation using Pelvipower. Muscle strengthening techniques are only used when there is no resting tension in the pelvic floor muscles, so this is not something that will be a first line treatment method.
What is premature?
A study involving 500 couples found the average time for ejaculation was about five-and-a-half minutes after starting sex. This time could be longer in the case of men who have sex with men. International guidelines define premature ejaculation as regularly ejaculating within one minute of entering your partner. However, it is up to you and your partner to decide if you are happy with the time it takes you to ejaculate. If ejaculation times are causing you persistent distress then it is a problem that can be helped with treatment.
Types of premature ejaculation
There are two types of premature ejaculation:
- primary premature ejaculation – where you have always had the problem
- secondary premature ejaculation (or “acquired premature ejaculation”) – where you recently developed the problem
The causes of primary premature ejaculation are often psychological, such as having a traumatic sexual experience at an early age. Secondary premature ejaculation can be caused by both psychological and physical factors. Physical causes can include drinking too much alcohol and inflammation of the prostate gland (prostatitis)
If your premature ejaculation is caused by a physical condition, treating the underlying condition should help. Your doctor can suggest possible treatment options.
Treating premature ejaculation caused by psychological factors can be more challenging. However, most men who persevere with treatment find the problem resolves.
There are a number of self-help techniques you can try before seeking medical help.
- masturbating an hour or two before having sex
- using a thick condom to help decrease sensation.
- taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body, during which ejaculation occurs)
- having sex with your partner on top (to allow them to pull away when you are close to ejaculating)
- taking breaks during sex and distracting yourself by thinking about something completely different
- If you are in a long-term relationship, you may benefit from having couples therapy.
You will be encouraged to explore issues that may be affecting your relationship and be given advice on how to resolve them. You may also be shown techniques that can help you ‘unlearn’ the habit of premature ejaculation.
Selective serotonin reuptake inhibitors (SSRIs) are available if the above self-help techniques don’t improve the problem. SSRIs are mainly used to treat depression, but one of their side effects is delaying ejaculation.
Some SSRIs are specifically designed to treat premature ejaculation. But a doctor may recommend you try another kind of SSRI on an “off-label” basis. This is when a medication is used for a different purpose than it was licensed for. Doctors can prescribe medication on an off-label basis if they decide it is in the best interest of the patient on the basis of available evidence.
Analgesics. Tramadol is a medication commonly used to treat pain. It also has side effects that delay ejaculation. Unwanted side effects might include nausea, headache, sleepiness and dizziness.
Phosphodiesterase-5 inhibitors. Some medications used to treat erectile dysfunction, such as sildenafil (Viagra), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn), also might help premature ejaculation. Unwanted side effects might include headache, facial flushing and indigestion. These medications might be more effective when used in combination with an SSRI.
The pause-squeeze technique
This method works as follows:
- Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
- Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
- Have your partner repeat the squeeze process as necessary.
By repeating as many times as necessary, you can reach the point of entering your partner without ejaculating. After some practice sessions, the feeling of knowing how to delay ejaculation might become a habit that no longer requires the pause-squeeze technique.
If the pause-squeeze technique causes pain or discomfort, another technique is to stop sexual stimulation just prior to ejaculation, wait until the level of arousal has diminished and then start again. This approach is known as the stop-start technique.
Condoms might decrease penis sensitivity, which can help delay ejaculation. “Climax control” condoms are available over the counter. These condoms contain numbing agents such as benzocaine or lidocaine or are made of thicker latex to delay ejaculation. Examples include Trojan Extended, Durex Performax Intense and Lifestyles Everlast Intense.
Anaesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation.
A lidocaine-prilocaine cream for premature ejaculation (EMLA) is available by prescription. Lidocaine sprays for premature ejaculation are available over the counter.
Although topical anaesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. Sometimes, female partners also have reported these effects.
Combining an anaesthetic cream with a condom can be particularly effective
Men require a strong pelvic floor as much as women. The PelviPower RPMS method helps men experiencing erectile dysfunction and impotence. It stimulates blood flow to the genitals and normalises muscle tone in the pelvic floor. PelviPower can also significantly improve the situation of men affected by incontinence after prostate surgery. Whether it is used in rehab facilities or to prepare for surgery on the urogenital system.
The blood vessels, the nervous system, the hormones and muscles must interact to ensure a sustained erection. The pelvic floor plays a significant role in achieving and sustaining an erection as well as during ejaculation: The muscles provide pressure in the corpora cavernosa and prevent blood from draining away. If the impotence you experience is due to a weak pelvic floor, there is a risk that it may develop into incontinence in later years. Training the pelvic floor with PelviPower can improve both potency and counteract the risk of incontinence.
The pelvic floor plays a significant role prior to and after a radical prostatectomy (removal of the prostate). The external pressure on the urethra is gone after a prostatectomy. You may experience unintentional leakage of urine and incontinence if your pelvic floor is too weak. Estimates suggest that every second man does not plan for sufficient rehabilitation after cancer therapy – despite the massive effects on everyday life. PelviPower training helps you strengthen your pelvic floor, regain your continence and prevent erectile dysfunction.
In summary, Pelvipower provides
- Help against erectile dysfunction.
- Stimulation of blood flow in the genital area
- Potency increase and better sex.
- Help before/after a prostatectomy (prostate removal) with incontinence problems
Prevention and improvement of incontinence
Our Physiotherapy Clinic Services
The West Wimbledon Physiotherapy Clinic aims to provide a selection of services to maintain and enhance health and wellbeing. Although primarily a physiotherapy clinic, a range of other treatments are available.