Male Pelvic Pain and Pelvic Pain in People with Male Anatomy
Reduce pain and restore function with pelvic floor physical therapy.
Disclaimer: Please note that throughout this page we will be using the terms “people with male anatomy” when discussing clinical presentation and anatomy. We have chosen these terms as they feel to be best practice at this time, but we acknowledge that gender and biological sex are a spectrum and language does not fully encapsulate that. We will continue to review and update this language as the discourse around this terminology continues to evolve.
Pelvic pain is a common condition that can affect people with male anatomy of all ages. It can be caused by a variety of factors, such as a bacterial infection, inflammation, nerve injury, organ dysfunction, or musculoskeletal dysfunction. Anxiety or excessive straining while exercising can also be a factor. Treatment options will depend on the underlying cause of the condition. Your doctor may recommend medication, surgery, or physical therapy to help alleviate your symptoms and improve your quality of life. Let’s explore how pelvic floor physical therapy can help alleviate your pain and discomfort.
Common Symptoms of Pelvic Pain in People with Male Anatomy
- Pain with sitting
- Pain at scrotum or testicles
- Abdominal sensitivity or pain
- Sensitivity at tip of penis
- Penile changes – such as “shrink” or doesn’t enlarge like it used to
- Pain in rectum
- Erectile dysfunction
- Pain during/after urination/defecation/orgasm
Associated complaints that may exist:
- Urinary urgency
- Urinary frequency
- Burning with urination
- Incomplete bladder voiding
- Constipation
- Incomplete bowel voiding
- Orofacial pain
- Incomplete ejaculation
- Difficulty achieving or maintaining an erection
Experiencing pelvic pain? Our team can help.
Common Diagnosis of Pelvic Pain in People with Male Anatomy
Prostatitis is an inflammation-related disorder that affects the prostate gland. It often results in painful or difficult urination, as well as discomfort in the pelvic area, groin, or genitals. Although bacterial infections are responsible for some cases of prostatitis, not all cases are caused by them. If true bacterial prostatitis is present, symptoms should resolve with antibiotics.
The prostate gland, roughly the size of a walnut, is located beneath the bladder in men. It encircles the upper part of the urethra, which is the tube that carries urine from the bladder. The prostate gland, along with other sex glands, produces semen, which is responsible for transporting sperm during ejaculation.
Types of Prostatitis:
Type #1 – Acute Bacterial Prostatitis:
Defined as acute sudden pelvic pain, usually accompanied by fever and other signs of bacterial infection. Responds to antibiotics.
Type #2 – Chronic Bacterial Prostatitis:
Recurrent pelvic pain without fever or signs of bacterial infection. Typically associated with bacteria in urine or prostate fluid. Long term antibiotics are needed.
Type #3 – Chronic Abacterial (Chronic Pelvic Pain Syndrome):
Chronic pelvic pain that is not associated with infection or bacteria in urine or prostate secretions. This accounts for 90-95% of all prostatitis diagnosis.
Common symptoms and interventions
- General Pelvic Pain – pain with sitting at scrotum or testicles, abdominal sensitivity or pain, sensitivity at tip of penis, pain in rectum
- Manual therapy, exercises, stretches, desensitization, behavioral modifications, postural correction
- Urinary dysfunction – painful voiding, incomplete voiding, increased urinary frequency
- Dietary modifications, bladder retraining, medication (alpha blockers, anticholinergics)
- Palpable tenderness/spasms/TrP in abdomen and pelvis
- Physical therapy, muscle relaxants (valium suppositories), exercise
- Psychosocial considerations – depression, stress, anxiety
- Talk therapy/counseling, antidepressants, mindfulness and meditation, breathing
Type #4 – Asymptomatic Inflammatory:
Inflammation of the prostate without symptoms. This is common in patients with benign prostatic hyperplasia, or non-cancerous enlargement of the prostate.
Chronic Testicular Pain also known as orchialgia or chronic scrotal pain is a condition characterized by persistent pain in the scrotum that is difficult to diagnose. This condition may have a sudden onset, with severe pain, or it may gradually develop and last for more than three months.
Penile Pain can occur in any area of the organ, including the base, shaft, or glans of the penis, and can affect voiding, sexual activity, general physical activity, and even wearing clothes. Pain may be constant or sporadic, and can be caused by a range of factors.
Causes:
- Intracavernous injection of drugs for erectile dysfunction
- Paraphimosis (constriction of the glans penis by foreskin)
- Priapism (persistent and painful erections unrelated to sexual arousal)
- Penile prosthesis surgery
- Penile changes – such as “shrink” or doesn’t enlarge like it used to
- Peyronie’s disease (development of fibrous scar tissue inside the penis),
- Circumcision
- Herpes genitalis
- Ilioinguinal nerve entrapment (supplies base of penis)
Muscle Overactivity occurs when the muscles in the pelvic floor become too tight and fail to relax properly. This can lead to a range of uncomfortable and often painful symptoms, including pain in the pelvic region, difficulty achieving or maintaining an erection, urinary incontinence or difficulty urinating, constipation or diarrhea, trigger points that cause pain in other areas of the body, and nerve impingement that can lead to additional complications.
Benign Prostatic Hyperplasia (BPH), or an enlarged prostate, occurs when the prostate gland, which helps make semen and is located below the bladder, grows larger with age. 80% of people with a prostate develop BPH. The prostate grows inwards and can constrict the urethra, causing symptoms of weak urinary stream, stop and go stream, difficulty starting a stream of urine. 1/3 of people with BPH develop lower urinary tract symptoms.
Symptoms:
- Constriction/obstruction of urethra makes the bladder work harder to eliminate urine – bladder walls (smooth muscle) thicken
- Thickened bladder walls = not able to store as much urine, this causes urinary urge threshold to decrease and urinary frequency to increase
- Bladder cannot empty completely – urethra is constricted, leading to increased pressure below, bladder can’t work hard enough to empty – leads to urinary retention
- Retention and residual urine can lead to infection or bladder stones – kidney injury can occur
Post-Vasectomy Pain Syndrome (PVPS) is a medical condition characterized by chronic pain in one or both testicles that lasts for over three months after the procedure. The pain can vary in intensity from a dull, occasional ache to a sharp, persistent pain that can disrupt daily activities. In some cases, the pain may be severe enough to require medical attention. Occurs in about 15 percent of people with a vasectomy.
Causes:
- Inflammation
- Pressure on vas deferens – sperm is still being produced, eventually acclimates
- Vascular stasis
- Nerve impingement, fibrosis around nerve
Pudendal Neuralgia , or pudendal nerve entrapment, refers to chronic pelvic pain resulting from injury or irritation to the pudendal nerve. When this nerve is damaged or compressed, it can cause various symptoms such as sharp, burning or shooting pain and radiate to the rectum, perineum, or penis.
Interstitial Cystitis (IC) or painful bladder syndrome is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe pain.
Types of IC:
- Ulcerative (lesions, not actual ulcers)
- Non-ulcerative: bladder hemorrhages suggesting irritation or inflammation
Hard flaccid syndrome (HFS) is a persistent and painful condition that is characterized by several symptoms, including a semi-rigid penis while flaccid, a soft glans while erect, pelvic pain, low libido, erectile dysfunction, erectile pain, pain during ejaculation, numbing or cooling of the penis, urinary tract issues, and psychological distress.
Hernias typically occur when a muscle in the stomach or pelvic area becomes weakened, resulting in a protrusion of tissue or an organ through the weakened area. This often leads to pain and observable bulging. Different types of hernias include inguinal, hiatal, and umbilical hernias. Inguinal hernias are the most common and occur when tissue or an organ bulges through a weak spot in the groin area. Hiatal hernias happen when the upper part of the stomach protrudes through the diaphragm into the chest cavity, and umbilical hernias occur when tissue or an organ bulges through the abdominal wall near the belly button.
Benefits of Working with a Pelvic Floor Physical Therapist
- Ease pain and discomfort
- Reduce tension from tight muscles
- Improve overall function and mobility through hands-on work and at-home exercises
- Restore the length-tension relationship of your pelvic floor muscles
- Improve blood circulation, which promotes healing
- Restore optimal whole-body performance
What To Expect
During Your Initial Appointment
These internal manual techniques are applied to the structures of the pelvis. This includes the pelvic floor muscles, nerves, and bones. We want you to be as comfortable as possible during the session – you have the right to refuse any treatment at any time without explanation.
Your PT will also provide you with exercises to begin at home to address your symptoms and ease your pain. These at-home exercises are customized specifically based on your needs.
During Your Additional Appointments
Each pelvic floor physical therapy appointment is one hour long. Your physical therapist might spend that time performing manual therapy, teaching you movement techniques and exercises, discussing your progress, answering questions, providing patient education and reviewing your at-home program.
Most individuals notice an improvement in symptoms within 8 weeks (or sooner).
How Pelvic Floor Physical Therapy Can Help with Pelvic Pain
Pelvic floor PT can help treat the underlying root causes of your symptoms for long-term relief. Physical therapists who practice pelvic floor physical therapy are highly trained to treat the muscles of the pelvic floor as well as other structures like your abdominal viscera and the muscles and joints of your spine and hips, which also play a role in pelvic floor dysfunction. A well-trained physical therapist is competent in navigating the treatment of such sensitive and personal structures and will go to great lengths to ensure that you feel comfortable, safe, and confident in your course of treatment.
Reduce your pelvic pain today.
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Beyond Basics: We Can Help
At Beyond Basics, we are committed to treating pelvic floor issues with sensitivity to each individual’s needs, regardless of sex, race, identity, age, or orientation – we treat the whole person with a comprehensive, caring biopsychosocial approach.
Since 2003, Beyond Basics has been a place of hope and healing for our patients. We believe skilled and compassionate healing can restore your body’s harmony and balance. Founder, Amy Stein, and co-founder, Corey Hazama are renowned experts and leaders in pelvic floor PT.
The skilled physical therapists at Beyond Basics receive extensive training to qualify them to be the world’s leaders in pelvic floor rehabilitation. All of our therapists have been carefully selected to work at Beyond Basics because they possess the right expertise, kindness, and empathy to allow them to excel at our practice. Our therapists have completed hundreds of additional hours outside of their doctorates both internally and externally through institutes such as Herman and Wallace and the American Physical Therapy Association, to help hone their practice and provide exceptional treatment efficiently and compassionately. In addition to being the world’s first and foremost experts in pelvic floor dysfunction, our individual therapists have cultivated additional skills unique to their own personal interests. Read more about each one of our therapists here.
