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Erectile Dysfunction Ask The Expert Kegel Exercises and Erectile Dysfunction Posted 01/17/2003 from Medscape Urology Question How effective are Kegel exercises for a patient who is suffering from ED caused by leaking veins? What additional treatments should also be considered? Response from Ira D. Sharlip, MD, 01/17/2003 Kegel exercises have no efficacy in the treatment of erectile dysfunction (ED) caused by corporovenous occlusive disease (CVOD or "leaking veins") or any other abnormality. There is no significant evidence that Kegel exercises can produce any durable physiologic change that would improve erectile function. CVOD is almost always a manifestation of another underlying cause of ED, such as cavernous arterial insufficiency or cavernous fibrosis; it is very rarely a primary cause of ED. Therefore, most cases of ED cannot be treated by treating CVOD; the underlying abnormality must be corrected, if possible. In the rare patient whose ED is due specifically to CVOD, surgical or radiologic ablation of the specific "leaking veins" may be considered, but these patients are very rare. In the great majority of men with ED whose CVOD is a result of other pathology, an oral phosphodiesterase should be tried as first-line therapy. If this is unsuccessful, second-line therapy with intracavernous injections, intraurethral alprostadil, or vacuum devices can be tried. Third-line therapy with penile prosthesis implantation is also an option if first- and second-line therapies fail.

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