You may not discuss it at the football game or the local bar, but issues like erectile dysfunction, premature ejaculation, and urinary incontinence occupy the thoughts of more men than you might expect.

In my clinical experience, I encounter a variety of individuals wrestling with these conditions. Many others suffer in silence due to embarrassment or a lack of knowledge on how to address them.

About one in five men over 40 experience erectile dysfunction, one in three face premature ejaculation, and one in six Australian men deal with urinary incontinence. The associated shame and stigma are substantial, often taking a heavy toll.

This is reminiscent of how women’s health issues, such as vaginismus, endometriosis, or even menopause, have long been overlooked. The reluctance to discuss male sexual health is equally profound, and it’s time we bring these discussions to the forefront.

Erectile dysfunction and premature ejaculation 

Erectile Dysfunction (ED) and Premature Ejaculation (PE) are among the most frequent sexual health issues for men. ED, characterized by difficulties in achieving or maintaining an erection, is particularly prevalent among men aged 45 and older, while premature ejaculation (reaching orgasm too quickly) can affect men irrespective of age.

Both issues can cause embarrassment, unnecessarily complicating intimacy. For some men, they may even discourage attempts to maintain a sexual life.

A number of factors contribute to these conditions. The likelihood of erectile dysfunction increases as people get older, due to the gradual blockage of blood vessels and the deterioration of nerve fibres over time. 

Nerves and blood vessels in the pelvis are also affected by smoking, alcohol, recreational drug use, low testosterone, diabetes, some neurological conditions, prostate surgery and pelvic radiotherapy. 

Anxiety and stress can also play a role in ED and PE.

Pelvic floor weakness is often overlooked in men. It’s usually associated with urinary incontinence, but also plays a crucial role in issues like erectile dysfunction and premature ejaculation.

Just as women experience weaker pelvic floor muscles with age, so do men – but pelvic health advice frequently focuses on women. Pelvic floor exercises can improve continence and sexual function, but most men are never shown how to do them.

Pelvic physiotherapists are amazingly skilled, but most clinics are targeted toward women’s health, leaving men feeling left out. When blokes finally muster up the courage to to walk into a clinic decked out in pink, it’s common to discover they’ve been exercising the wrong muscles for years – unsurprisingly with zero benefit.

Most medical solutions for erectile dysfunction involve pills, vacuum pumps, or penile injections. While these approaches can be helpful, they may not be suitable for everyone. Men’s pelvic floor strength is often left out of the conversation, and other practical approaches to treatment are rarely discussed.

Pills, pumps and injections: what to know

The most recognised treatment for erectile dysfunction (ED) is Viagra (sildenafil), a medication that enhances blood flow to the penis, helping maintain a firmer erection for longer periods of time. Many users report improved erection firmness; however, common side effects include facial flushing, headaches and dizziness.

Another option is tadalafil (Cialis), which lasts longer and is available in both daily (low-dose) and ‘as needed’ (higher-dose) formulations. Urologists often recommend taking tadalafil daily after pelvic surgery to promote blood flow. 

However, tadalafil isn’t suitable for everyone. Some men struggle with side effects or find the ongoing cost prohibitive.

If tablets are unsuitable or ineffective, then penile injections are sometimes suggested. However, many men understandably don’t want to inject medication into their penis, which can be painful, and can cause bruising or even scarring.

Both pills and injections come with a small risk of priapism, a tight erection that won’t go down. After a few hours, this can become more painful and is considered a medical emergency, requiring urgent medical attention.

Embarrassment is another big hurdle. Some men are too shy to talk to their GP about their sexual health and seek medication online. Medication posted to your front doorstep may be convenient and discreet, but it’s impossible to know if the medicine you’ve received is the one you’ve been expecting. 

Fake medicine may be ineffective or dangerous.

Online clinics can offer convenience, allowing men to avoid potentially uncomfortable in-person conversations with their regular GP. However, some of these clinics take advantage of vulnerable patients by charging steep prices for treatments that are typically quite affordable.

It’s worth noting that medications commonly used for treating erectile dysfunction are often not effective in treating premature ejaculation.

Emsella: a new approach for ED and PE

A new non-invasive treatment designed to strengthen pelvic floor muscles was approved for use in Australia in 2018 and is gradually becoming available around the country. This treatment utilises High-Intensity Focused ElectroMagnetic (HIFEM) technology to stimulate the pelvic floor muscles without the need for medication.

The device, known as Emsella, is non-invasive, and resembles a futuristic toilet where the patient sits fully clothed on the ‘throne’. 

Most people start with a protocol of 30-minute sessions, three times a week for two weeks. During a 30-minute session it delivers over 11,000 powerful contractions that mimic pelvic floor exercises. These contractions are classified as supramaximal, meaning they are stronger than those a person could produce on their own.

Additionally, the sheer number of contractions far exceeds what you could realistically achieve by yourself in the same time period. Evidence suggests Emsella helps to strengthen key pelvic floor muscles, encourages better blood flow, and can support both getting and keeping an erection for longer.

The Australian Register of Therapeutic Goods (ARTG) states that, ‘In Australia EMSELLA® is intended to provide pelvic floor muscle strengthening for treatment of genitourinary system diseases/disorders such as urinary incontinence, urinary incontinence after radical prostatectomy, female sexual dysfunction, erectile dysfunction, postpartum pelvic floor dysfunction and pelvic pain syndrome in male and female patients.’

Emerging evidence also suggests that Emsella can provide symptomatic relief for men with premature ejaculation, helping them gain better control over their pelvic floor, delay orgasm, and enhance their sexual enjoyment.

There’s no pain – just a sensation of the muscles tightening and relaxing. Many say they notice a difference even after one session, and for some, it’s the first time they’ve ever felt their pelvic floor muscles working.

After the initial protocol period of two weeks, maintenance treatment is required to keep the muscles strong. ‘Top-ups’ can be performed weekly, or monthly.

Cost

Emsella does come at a price – the first round of sessions usually costs $1,500 to $2,500, with maintenance treatments around $75 to $150 per month thereafter. Unfortunately, this puts it out of reach of many people who could benefit from it.

When might Emsella be considered?

Emsella may be an option for men who can’t or don’t want to use medication or injections, and there are minimal side effects.

It’s mainly being used by patients wanting to treat urinary incontinence, but research has increasingly shown benefits for patients with erectile dysfunction and premature ejaculation – an area with very few effective treatments. 

Some patients have even used Emsella before and after prostate cancer surgery to help keep their pelvic floor strong. It’s not recommended for people with an implanted pacemaker or fitted with other internal electronic devices.

There’s no one-size-fits-all answer here, but just knowing what your options are – and having an open chat with your doctor – is a really good starting point.

Every bloke’s situation is different, and your GP can help you work out which approach feels right for you.

Brad McKay is a medical practitioner, author, TV host, and media commentator. Since his role as the host of Embarrassing Bodies Down Under and the release of his book Fake Medicine: Exposing the wellness crazes, cons, and quacks costing us our health, he’s emerged as one of the leading voices in Australian healthcare 

This article is for general informational purposes only and does not constitute medical advice. Therapeutic goods and treatments mentioned, including medications and medical devices, may not be suitable for everyone. Always consult a qualified healthcare professional before starting, changing, or stopping any treatment.

This content complies with the Therapeutic Goods Administration (TGA) guidelines by avoiding misleading claims, ensuring accuracy, and encouraging consumers to seek appropriate medical advice.

Emsella® is included on the Australian Register of Therapeutic Goods (ARTG) for specific indications. Outcomes may vary depending on individual circumstances.