NOTE: This article contains sexual content intended for a mature audience. Let’s clear the air and say that first and foremost, men have pelvic floors. There, I said it. Yes, and aside from two distinct muscles, they function similar to a female’s pelvic floor. The muscles of the pelvic floor serve important roles in urinary and bowel control, sexual function, and act as a supportive system for the body. So, what happens when your pelvic floor muscles act up? A number of symptoms can occur, but for this blog series we’re going to talk specifically about pain during and after sex. The Orgasm Our focus today is primarily on the finale of sex, the orgasm. Now to be clear, a person can have an orgasm and not ejaculate, and a person can also ejaculate without having an orgasm. Typically these actions occur simultaneously but not always. Why are we talking about orgasms? Well, because when the muscles of the pelvic floor aren’t working in perfect harmony a lot of things tend to go awry. Things like erectile dysfunction, premature ejaculation, discomfort in the testicles, and pain during or after ejaculation are all potential indicators of pelvic floor dysfunction. Having a successful sexual encounter requires a beautiful symphony of interactions between your pelvic floor muscles, vascular supply, hormones, sensory input, and brain capacity. When all of these players are playing well together on the same team, it can and should lead to a pleasurable release. Before we go any further, let's break down the anatomy and physiology of ejaculation. It happens in two parts: emission and expulsion. The emission phase happens when semen is created by combining fluids from the prostate, seminal vesicles, and vas deferens (the tubes that carry semen from the testicles to the penis). Expulsion is the muscular contraction of the pelvic floor muscles which propels the semen into the urethra and out of the penis. This is the part of the climax portion of sex that can cause pain if the pelvic floor muscles aren’t working properly. Generally speaking, in order for muscles to function appropriately and pain free, they have to be able to move (contract/relax) through their full range of motion. When a muscle is consistently held in a tightly wound position and isn't allowed to relax into a fully lengthened position, this shortened position becomes its new normal. Clinically speaking, people who have pelvic pain are typically in an overactive, contracted pelvic floor position. They chronically hold tension in their muscles; and when under additional stress during sexual intercourse, their pelvic floor muscles can cause pain by compressing other structures like the urethra, blood vessels, or vas deferens. What else could it be? Pain during or after ejaculation is often diagnosed (or misdiagnosed) as prostatitis. The most common form of prostatitis is the National Institute of Health’s category III, also known as Chronic abacterial Prostatitis (CP) or Chronic Pelvic Pain Syndrome (CPPS). Prostatitis is an inflammation of the prostate and those with a CP/CPPS diagnosis have probably seen numerous healthcare providers and been treated with an extensive list of interventions including antibiotics. Prostatitis is a very common diagnosis because it presents with similar symptoms such as painful urination and pain with ejaculation. However, keep in mind that prostatitis is an inflammatory condition. If diagnostic tests don’t reveal an infection in the prostate, it’s probably not prostatitis and those antibiotics that were prescribed likely won’t work. So if it’s not an infection of my prostate, then what's causing my pain? Well, when held in a chronic stressed or contracted position, your pelvic floor muscles can create similar symptoms to a Urinary Tract Infection (UTI) or an inflamed prostate. For instance, besides pelvic pain, those with a "prostatitis" diagnosis may also experience other pelvic floor dysfunction symptoms such as:
There is also a large correlation of emotional distress, anxiety, and fear related to pelvic floor dysfunction which can exacerbate your symptoms. However, if you’ve seen a urologist or primary care physician, and they’ve ruled out other medical diagnoses (UTI, prostatitis, cancer, etc.) to explain your symptoms, your painful climax could be coming from your muscles. Pelvic floor dysfunction is treatable (and preventable) As an orthopedic physical therapist and pelvic health specialist, I work with many people who have all kinds of sexual problems due to pelvic floor dysfunction. It is much more prevalent than you might think. I perform a thorough medical history, pelvic examination, and movement screen to get to the underlying source of your condition. My treatments are all private and often include skilled internal manual therapy work, neuromuscular retraining, muscle coordination, breathing and other therapeutic strategies, as well as exercise prescription for safe movement and self-care techniques to manage the symptoms at home. If you feel like you have pain in your penis after sex, or more specifically ejaculation, or any of the above symptoms, it could be possible that you have pelvic floor dysfunction. If this sounds like you, reach out to me or one of our other pelvic floor therapists at Activcore to schedule a consultation. Check out our Pelvic Health page to learn more about how a physical therapist can help you overcome pelvic floor dysfunction. Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions. Need help? We're here for you. Contact us today to request an appointment. Also check out our Telehealth offerings to get help from the comfort of your home. REFERENCES: Anderson, R. U., Sawyer, T., Wise, D., Morey, A., & Nathanson, B. H. (2009). Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. The Journal of urology, 182(6), 2753-2758. Potts, J. M., & O’Dougherty, E. (2000). Pelvic floor physical therapy for patients with prostatitis. Current urology reports, 1(2), 155-158. Rosenbaum, T. Y. (2007). REVIEWS: Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. The journal of sexual medicine, 4(1), 4-13. |
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