PT for Your ED Part 2: Donna Lee and Dr. Treadway Discuss Pelvic Floor Physical Therapy for Erectile Dysfunction

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Donna Lee is joined by NAU Urology Specialists' wonderful pelvic floor physical therapist, Dr. Angela Treadway for Part 2 of a previous podcast, "PT for Your ED: Dr. Angela Treadway Discusses Pelvic Floor Physical Therapy and Erectile Dysfunction" (aired 8.8.20).  Dr. Treadway explains what a pelvic floor physical therapist does and some of the many benefits male urology patients can gain from PT. In particular, Dr. Treadway explains how erectile dysfunction can be treated through physical therapy. She points out that in order for the erectile tissues to engorge, the musculature around those tissues have to be loose enough to allow the blood to flow, but not so loose that the tissues empty prematurely. Using biofeedback monitors, Dr. Treadway helps "coach" patients to do exercises that improve the function of affected musculature and thereby improve "game performance" in the bedroom. There is also a cognitive component that can affect blood flow--when the brain and body go into "fight-or-flight" mode, blood is redirected toward the thighs to enhance one's ability to flee from a dangerous predator. All of these issues can be addressed through physical therapy and sometimes sex therapy to address the cognitive components of ED. 

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Episode Transcript

Speaker 1 (00:09):
Welcome back to the Armor Men's Health Hour with Dr.
Mistry and Donna Lee.

Donna Lee (00:16):
Welcome to the Armor Men's Health Hour.
Today, Dr.
Mistry has stepped away for amoment.
So we brought in our superamazing special partner in
health and sometimes in crime,Dr.
Angela Treadway! Welcome, Dr.
Treadway.

Dr. Treadway (00:28):
Thanks.
Good to be here.

Donna Lee (00:30):
Not ever in crime.
I'm just kidding.

Dr. Treadway (00:33):
Not out loud.

Donna Lee (00:33):
Always in wellness and health, for sure.
You can visit our website andsee Dr.
Angela Treadway's beautiful,smiling face at
armormenshealth.com.
You can send her questions or mequestions, or we'll get them
answered anonymously [e-mail].
Our phone number during the weekis(512) 238-0762.
You can catch our podcastswherever you listen to podcasts.

(00:53):
Dr.
Treadway, you can hear Dr.
Treadway.
You can actually Google us,"Armor Men's Health" and"Dr.
Treadway," and she has--we'vedone like 500 podcasts--yours is
the third most downloadedpodcast that we have, which is a
lot.
It says a lot.

Dr. Treadway (01:04):
That, that's really gratifying.

Donna Lee (01:06):
Thank you so much.
I think, we also feature you inour series called"That's What
She Said!" So we wanted to haveher back.
Thank you so much, Dr.
Treadway, for being here.

Dr. Treadway (01:14):
I am so happy to be here.

Donna Lee (01:15):
So that first one was called, we talked about erectile
dysfunction.

Dr. Treadway (01:18):
We did that's the third most downloaded.

Donna Lee (01:20):
Right.
It was like"PT for your ED.

Dr. Treadway (01:23):
"PT for your ED." And this will be"PT for your ED:
The Sequel."

Donna Lee (01:27):
Part 2.
That's right.
So let's take it away.
What do you want to talk about?
Let's, let's inform all thelisteners: what you do, how you
fix the erectiledysfunction--because guys don't
think about pelvic floorphysical therapy sometimes.

Dr. Treadway (01:38):
No, no, it's not actually promoted a lot like the
medications are and such.
It doesn't have as muchadvertising time.

Donna Lee (01:47):
Pizzaz.

Dr. Treadway (01:47):
Right?
Not so much pizzaz because it'snot a pill.
It's not magic.
It doesn't, it takes a littleeffort.

Donna Lee (01:53):
A little bit of work.

Dr. Treadway (01:53):
PT is, physical therapy is like training.
I am your coach, you are theathlete.
You get the gold medal and I'llshow you how to get it.
So things to think about witherectile function--how does it
work?
You got to have blood flow andyou got to have appropriate
pressure.
Got to get closer to themicrophone and stay in my video.
Those of you watching thisvideo--I'm actually videoing

(02:14):
this right now--you will be mybeta testers.
I've never done this before.
Maiden voyage.

Donna Lee (02:19):
That's right.
You can see Dr.
Treadway, but not me.
Thank goodness.

Dr. Treadway (02:21):
You don't love me anymore.
Okay.
So blood flow, blood pressure,strength.
The, if you think about thechambers of the penis that have
to be able to engorge, they havesmall arterials and those
arterials have smooth musclearound them.
Now smooth muscle is veryaffected by the autonomic
nervous system, which is thepart of the nervous system which

(02:43):
does fight or flight, rest anddigest.
This is why, if you're runningfrom a tiger, you don't want to
make babies.
So if stress is in your life...

Donna Lee (02:51):
You're not getting an erection when you're running
from some death.

Dr. Treadway (02:56):
Pretty much, you kind of hope not.
But that's a thing to thinkabout.
It's a cause effect, and you'vegot to be in the right chemistry
to get things going, number one.
Number two, you've got to haveenough patency, openness,
compliance in the tissues thathave to engorge.
So they have to not be tightbecause you're in fight or
flight, smooth muscles have tolet go and allow the blood in.

(03:17):
Now as the blood comes in, aslong as you don't have any, any
blockages, any plaques andthings like that, as the blood
comes in, you can actually do acouple of things to help it,
hasten it to stay there to causemore rigidity.
There are muscles underneath thepenis.
One is called thebulbocavernosus, it's directly
underneath.
So if you were to do a penislift, you're contracting it.

(03:38):
That muscle will take the bloodfrom the vascular compartment
and push it into those littlearterials.
And by doing that, it's not justthat one.
There's another set on the sidethat are ischiocavernosus--you
don't need to know the names,there won't be a test--but
essentially what you try to dois a penis lift, and you will
bring those into play.
And what they'll do is take theblood from the vascular

(03:59):
compartment, put it into thecavernous tissue.
The anterior fibers of thebulbocaversnosus will also
compress the vein.
There's a vein on the penis thatis the drain vein.
It'll make it not drain.
So you get to have rigidity andyou get to keep it.
And one of the cool things thatthose muscles do for the geeks
in the audience is that theyincrease the blood pressure in

(04:20):
those arterials to go abovediastolic blood pressure, which
is what they have to do to getthe rigidity.
So there's blood pressureissues, that's tricky.
But that is the mechanism.
So what physical therapy, whatpelvic floor physical therapy
has to contribute to this wholesituation is that we have
apparatuses called biofeedbackthat you can get right up there

(04:41):
by that muscle that does thepenis lift so that you can look
on a screen and see when you'redoing it when you're not,
because really that part of thebody, our brain and our pelvic
floors, don't really talk toeach other a lot after we're
potty trained.
So it's been a lot of years.
So if they don't know how to doit, or I've never practiced that
I've got, I have got theequipment to help them see,

(05:02):
measure, get feedbackimmediately in real time and
then go home and practice.
The magic's in the homework.
It really is.
I'm just the coach.

Donna Lee (05:11):
And what are they doing when they're at home with
them?

Dr. Treadway (05:13):
When they're at home, they're going to practice
what they did with thebiofeedback.
They're going to practice thepenis lift and the let go of the
penis lifts so that they havecomplete mastery of that.
And...

Donna Lee (05:26):
It was so going to insert a joke, but I did not.
Go ahead.
Mastery of the penis.
Go ahead.

Dr. Treadway (05:34):
That is what they're going to do.
Oh.
And practice.
If fight or flight is a problemin the equation, then I will
also teach them mindfulnesstechniques.
I've got, I've got an apparatusfor that too.
I like the widgets, regeneratewires, anybody who comes to see

(05:56):
me is going to know this aboutme.
So I do have a geek side.
But I have an apparatus thatwill measure what's called heart
rate variability, which givesyou an indicator of coherence in
your organ systems.
And that is a lot of fancy wordsto say, getting you to be able
to on your own on purposebalance from fight or flight to

(06:18):
rest and digest so that you canactually get feedback and see
how you're doing.
And what you'll see, what you'llalways notice on that monitor is
what it is that went throughyour mind, that flashed through
your mind that took you out ofcoherence.
And you'll realize that yourthoughts have a lot to do with
your chemistry.

Donna Lee (06:34):
It sounds like therapy too, not just physical
therapy.
You're doing some therapy inthere.

Dr. Treadway (06:37):
Well people tell me a lot.
People tell me an awful lot ofstuff, and of course I can, I
can, refer to the appropriateplace if they need some, some
in-depth trained, you know, helpwith that.
Cause you know, we all havesomthing.

Donna Lee (06:52):
Right.
And we have sex therapy onsiteas well.
So I'm sure that some of yourpatients could benefit from
both.
A little bit of mine therapy, alittle bit of pelvic floor
physical therapy.

Dr. Treadway (07:01):
Well, it's a body mind thing.
And really our sexiest organ isour brain.
It really is.
A little more so with femalesbecause females are super
complicated when it comes toarousal and whatnot and males
aren't as complicated.
But still it's the brain, it'sthe brain, the eyes, you know,
all of that.
[inaudible]

Donna Lee (07:21):
Right.
Gotcha.
If I am a man with ED and I'mseeing Dr.
Treadway or Dr.
Lipe in our clinic, what does itlook like for a typical patient
with ED?
Is that a weekly visit with you?
Or is it every couple of weeks?
Like how do you, how often doyou want to see that patient?

Dr. Treadway (07:34):
I want to start by seeing them weekly for four to
six weeks, depending on theirmastery of that muscular area.
If they've got some mastery, wecan start with four and make
sure that they have adequatetraining to do that home program
without any apparatus, withoutany feedback.
And then from there we can dotwo week, three week follow-ups

(07:56):
to see how it's going.
Because you know, they got tohome and practice.
I need some feedback I need toknow if the intervention that
the coach is doing is making adifference in the bedroom, and
that way we can tweak it overthe first four weeks.
Four to six weeks is thephysiological timeline for a
neuromuscular slashmusculoskeletal change to take

(08:18):
you from the level that you'reat to the next level of
function.
So that's why I choose the fourweeks.
It's because of thephysiological timeline.

Donna Lee (08:27):
Right.
So it's not, you know, youcan't, it's not a one and done
kind of thing, guys.
If you're, if you've beenscheduled to see a physical
therapist for your pelvic floorfunction for your ED issues, I
don't want guys to go,"Oh, I'mgoing to go see Dr.
Treadway one time and I'm alldone."

Dr. Treadway (08:41):
We can try that and see how it works.
Let me know.
I mean, you know, I'm willing.
I'm willing to, I will give whatyou ask for.
If you're not willing to put inthe time or you can't put in the
time, I will do my best to giveyou the home program and give
you the education that I cangive in an hour in that first
visit.
I mean, I understand, you know,if, if stress is your problem,

(09:04):
then likely you don't have time.
But I am, I'm here to give whatI have to serve you.
And, where we meet with thisgive and take of information and
of basically neuromusculartraining, motor pattern

(09:24):
training, where we meet is whereyour benefit's going to be.
Right.
But I understand if you don'thave time, I, you know, I'm not
going to judge you.
I'm not gonna judge you.

Donna Lee (09:35):
So, and Dr.
Treadway is a pelvic floorphysical therapist.
And where did you go to schoolreal quick?

Dr. Treadway (09:41):
For PT?
I did my masters at ArcadiaUniversity in Philadelphia--or
actually Glenside, Pennsylvania.
And I did my doctorate at TempleUniversity in Philadelphia.

Donna Lee (09:50):
Gotcha.
And we also have our lovely Dr.
Lipe so you will have one ofthese two amazing humans
treating you.
Dr.
Treadway, thank you so much forcoming in for"PT to fix your ED
Part 2." And, and that's whatshe said.
So you can find Dr.
Treadway at our website,armormenshealth.com.
You can also send questions onthe specific topic or whatever

(10:12):
else you might have for Dr.
Treadway [e-mail].
And you can listen to ourpodcasts.
They're free.
They're amazing.
They are just as informative asa Joe Rogan podcast, but shorter
and maybe even funnier.
I'm just kidding.
Maybe not anyway.
Call us.
Thanks so much, Dr.
Treadway.

Dr. Treadway (10:30):
You're welcome.
This is fun.

(10:32):
Dr.
Mistry wants to hear from.
You email questions [e-mail].
We'll be right back with theArmor Men's Heath Hour.