A group of 150 consecutive male patients with erectile dysfunction and proven venous leakage were randomised either to surgery or to a pelvic floor training programme. The operative procedure consisted of dissection and removal of the deep dorsal vein of the penis and its tributaries or large veins that drain into the internal or external pudendal system. The training programme was given 5 times, in weekly sessions, and the patients were supervised by trained physiotherapists. Surgery was not superior to the pelvic floor training programme either subjectively or objectively. Moreover, a significant improvement was found following the training programme; 42% were satisfied with the outcome and refused surgery. Pelvic floor exercise is a realistic alternative to surgery in patients with mild degrees of venous leakage.