restoring sexual function, one can also improve QoL levels.
Although we had good QoL outcomes in the intervention
group, the small number of sessions prevents a deﬁnitive
conclusion; long-term results are needed before we can
claim that our protocol restores sexuality-related QoL. It is
hard to explain both lack of placebo effect in the CG and the
good improvement in the QoL of the IG. Looking indivi-
dually some of the control had a bit improvement but was
not signiﬁcant. And the few sessions that was done might
gave a feeling of enthusiasm for the intervention. But this is
just speculations. We would need a bigger study to have
more conclusive data about the results.
Our ﬁndings suggest that FES for ED is feasible and has
some beneﬁcial effect on erectile capacity and QoL in our
patients. One limitation of our study is the small sample
size, although it was sufﬁcient to show a clear statistical
difference in terms of recovery of erectile function on
comparison to the control group. Another limiting factor
was the length of follow-up, which was insufﬁcient to allow
evaluation of long-term results. Further studies should be
carried to corroborate our results, aiming to improve the
methods of evaluation establishing the physiopathology
pathways of the FES in the NO release, and ﬁnding selec-
tion criteria for patients suitable for this treatment.
Compliance with ethical standards
Conﬂict of interest The authors declare that they have no conﬂict of
1. NIH Consensus Development Panel on Impotence. Impotence-
NIH Consensus Conference. JAMA. 2013;270:83–90.
2. Pournaghash-Tehrani S, Etemadi S. ED and quality of life in
CABG patients: an intervention study using PRECEDE-
PROCEED educational program. Int J Impot Res. 2014;26:16–9.
3. McMahon CN, Smith CJ, Shabsigh R. Treating erectile dys-
function when PDE5 inhibitors fail. BMJ. 2006;332:589–92.
4. Hackett G. Patient preferences in treatment of erectile dysfunction:
the continuing importance of patient education. Clin Cornerstone.
5. Al-Shaiji T, Brock G. Phosphodiesterase Type 5 inhibitors for the
management of erectile dysfunction: preference and adherence to
treatment. Curr Pharm Des. 2009;15:3486–95.
6. Hwancheol S, Kwanjin P, Soo-Woong K, Jae-Seung P. Reasons
for discontinuation of sildenaﬁl citrate after successful restoration
of erectile function. Asian J Androl. 2004;6:117–20.
7. Claes H, Van Kampen M, Lysens R, Baert L. Pelvic ﬂoor exercise
in the treatment of impotence. Eur J Phys Med Rehabil.
8. Derouet H, Nolden W, Jost W, Osterhage J, Eckert R, Ziegler M.
Treatment of erectile dysfunction by an external ischiocavernous
muscle stimulator. Eur Urol. 1998;34:355–9.
9. Andersson K-E Erectile physiological and pathophysiological
pathways involved in erectile dysfunction. J Urol. 2003;170(2 Pt
10. Hurt KJ, Musicki B, Palese Ma, Crone JK, Becker RE, Moriarity
JL, et al. Akt-dependent phosphorylation of endothelial nitric-
oxide synthase mediates penile erection. Proc Natl Acad Sci USA.
11. Gratzke C, Angulo J, Chitaley K, Dai Y-T, Kim NN, Paick J-S,
et al. Anatomy, physiology, and pathophysiology of erectile
dysfunction. J Sex Med. 2010;7(1 Pt 2):445–75.
12. Stief CG, Weller E, Noack T, Djamilian M, Meschi M, Truss M,
et al. Functional electromyostimulation of the corpus cavernosum
penis--preliminary results of a novel therapeutic option for erectile
dysfunction. World J Urol. 1995;13:243–7.
13. Dean R, Lue TF. Physiology of penile erection and pathophy-
siology of erectile dysfunction. Urol Clin North Am.
14. Ignarro LJ, Bush PA, Buga GM, Wood KS, Fukuto JM, Rajfer J.
Nitric oxide and cyclic GMP formation upon electrical ﬁeld sti-
mulation cause relaxation of corpus cavernosum smooth muscle.
Biochem Biophys Res Commun. 1990;170:843–50.
15. Jiang J, He Y, Jiang R. Ultrastructural changes of penile caver-
nous tissue in multiple sclerotic rats. J Sex Med. 2009;6:
16. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D,
Montorsi F, et al. Guidelines on male sexual dysfunction: erectile
dysfunction and premature ejaculation. Eur Urol. 2010;57:
17. Paick J, Goldsmith P, Barta A, Nunes L, Padula C, Lue T.
Relationship between venous incompetence and cavernous nerve
injury: Ultrastructural alteration of cavernous smooth muscle in
the neurotomized dog. Int J Impot Res. 1991;3:173–84.
18. Myung-Cheol G, Yun-Chul O, Tae-Woo K. The effect of treat-
ment of erectile dysfunction with electrical stimulation. Kor J
19. Althof S. Quality of life and erectile dysfunction. Urology.
20. Araujo A, Durante R, Feldman H, Goldstein I, McKinlay J. The
relationship between depressive symptoms and male erectile
dysfunction: cross-sectional results from the Massachusetts Male
Aging Study. Psychosom Med. 1998;60:458–65.
21. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO,
Moreira ED, et al. Deﬁnitions/epidemiology/risk factors for sexual
dysfunction. J Sex Med. 2010;7(4 Pt 2):1598–607.
An initial study on the effect of functional electrical stimulation in erectile dysfunction: a. . .