Can Massage Help Erectile Dysfunction?

The 2025 European Association of Urology (EAU) Guidelines on Sexual and Reproductive Health do not recognize or recommend massage as an effective treatment option for erectile dysfunction (ED)¹. The guidelines provide a comprehensive treatment algorithm for ED, tailored to each patient according to the invasiveness, tolerability, and effectiveness of each option and the patient’s expectations, but massage therapy is not included among these recognized interventions². First-line treatments recommended by the EAU Guidelines include lifestyle modifications, addressing modifiable risk factors, and oral medications such as phosphodiesterase type 5 inhibitors (PDE5Is)³. These oral medications remain the standard first-line therapy for most men with ED due to their proven efficacy, ease of use, and favorable safety profile when properly prescribed⁴. For patients who do not respond to or cannot use oral medications, the guidelines recommend options including intracavernosal injections and, for well-informed patients who want a non-invasive, drug-free option, vacuum erection devices⁵. These treatments have demonstrated efficacy in clinical trials and are supported by the guidelines for appropriate patients, particularly those who cannot take or do not respond to oral medications⁶. Penile prosthesis implantation may be considered when other options are unsuitable or have not worked, or when a patient prefers a definitive therapy⁷. The EAU Guidelines recognize two main classes of penile implants: inflatable (two- and three-piece) and semi-rigid (malleable, mechanical, and soft flexible) prostheses⁸. These surgical interventions have high satisfaction rates (92-100% in patients and 91-95% in partners) with appropriate counseling⁹. Other emerging therapies mentioned in the guidelines include low-intensity shockwave therapy, which the guidelines weakly recommend for selected men with vasculogenic ED, and platelet-rich plasma injections, which should be used only in clinical trials¹⁰. However, even among these experimental approaches, massage is not mentioned or supported by any evidence in the guidelines¹¹. It’s important for patients experiencing erectile dysfunction to consult with healthcare providers who can recommend appropriate, evidence-based treatments according to their specific situation rather than pursuing unproven interventions like massage that lack scientific support in the authoritative guidelines¹².