The combination of electrotherapy with pelvic floor muscle training in the treatment of a patient with postcovid erectile dysfunction. Clinical case

Abstract

Demyelinating inflammation of the pudendal nerve associated with COVID-19 has been clinically identified in many cases and has been proven in animal experiments. Many authors associate the development of erectile dysfunction after suffering COVID-19 with endothelial disorders in the urethra and other endocrine and psychological disorders. In clinical practice, after the start of the COVID-19 pandemic, we have identified many cases of erectile dysfunction with confirmed neurophysiological and clinical disorders of the pudendal nerve. Despite active medical treatment, not all patients improve. In this regard, we decided to demonstrate this clinical case. The patient underwent a course of pelvic floor muscle training and transcutaneous electrical neurostimulation after the lack of effect of pharmacotherapy. The diagnosis of erectile dysfunction against the background of damage to the pudendal nerve as a result of a history of COVID-19 was established on the basis of the patient’s complaints, anamnesis, clinical picture, biochemical, neuroimaging and neurophysiological methods of research. Before treatment, the pain syndrome was 7/10 points, the strength of the pelvic floor muscles was 2/5 points, the erectile function according to the erectile function index was 8/30 points and the quality of life as a result of erectile dysfunction was 46/60 points. The use of transcutaneous electrical nerve stimulation of the pudendal nerve in combination with training of the pelvic floor muscles proved to be very effective in the treatment of patients with severe pudendal neuralgia accompanied by severe erectile dysfunction, weakness of the pelvic floor muscles and impaired urination. Against the background of debilitation, the pain syndrome regressed by 78%, erectile dysfunction decreased by 2 times, the quality of life improved by 82.6% and the strength of the pelvic floor muscles increased by 75% and urination disorders completely regressed.