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Pain in the Penis and Pelvic Floor Dysfunction

Mar 7, 2023

The biggest concern that men may have about their pelvic floor dysfunction is the impact it can have on their sexual function and quality of life. Pelvic floor dysfunction can cause a range of symptoms that can affect sexual health, such as pain or discomfort during sexual activity, difficulty achieving or maintaining an erection, or premature ejaculation. These symptoms can not only be physically uncomfortable but also lead to emotional distress and a decreased quality of life.

Men may feel embarrassed or stigmatized about discussing issues related to their pelvic floor function. This can make it difficult to seek medical attention or discuss concerns with healthcare providers. It’s important for men to understand that pelvic floor dysfunction is a common condition that can be effectively treated, and seeking medical attention is an important step in managing symptoms and improving overall health and well-being.

 

Symptoms of Pelvic Floor Dysfunction in Men vs Women

 

While in women, PFD can be associated with:

  • Pelvic pain or discomfort, often described as a dull ache or pressure
  • Pain during intercourse
  • Heaviness or bulging in the pelvic area, which may be a sign of pelvic organ prolapse
  • Difficulty emptying the bladder or bowel completely

In men, PFD can be associated with:

  • Pain in the rectum or perineum (the area between the scrotum and anus)
  • Pain in the penis and/or scrotum
  • Pain or discomfort during or after ejaculation
  • Erectile dysfunction
  • Difficulty starting or stopping urination
  • Incontinence after prostate surgery

There are, however, subtle symptoms that most often are not associated with pelvic floor dysfunction that are present WAY before the diagnosis of pelvic floor dysfunction. As stated in the blog: ” Pelvic Floor Dysfunction Symptoms” this includes:

  • “Lower back pain
  • Pain in the back joints of the pelvis (SI Joints)
  • Pain in the front pubic area
  • Arched lower back
  • Slouched lower back
  • Slouched mid-back or hunchback
  • Military posture with the chest pushed out
  • A V-stance where the torso is positioned behind the hip joints on the side view
  • Chronic forward neck
  • Inability to bend down below the knees
  • Habitually standing on one leg with the other leg bent
  • Chronic one-sided pain in the lower extremity
  • Hip pain on one or both sides”

 

What Causes Pain in the Penis?
Pain in the penis or penile pain can be mild or intense and can be present with all or some activities. There are several possible causes of penile pain related to pelvic floor dysfunction. One possible cause is pudendal neuralgia, which occurs when the pudendal nerve, which supplies sensation to the penis, becomes compressed or damaged. This can cause pain, numbness, or tingling in the penis, as well as pain in the perineum or rectum. This is further discussed in the blog series I have written on this subject.
Typically by the time a person with pain in the penis goes to a pelvic floor therapist (who may or may not be a physical therapist), many tests have been done and no long-term solution is made. It is then that the muscles of the pelvis are evaluated and treatment is primarily focused on the internal manual work through the anus.
I will first explain to you why we even consider the muscles of the pelvis and why I have an issue with internal manual work being the first line of work in treatment!
When the pelvic floor muscles become tight or weak, they can affect the blood flow and nerve function in the genital area, leading to pain or discomfort. In some cases, pelvic floor dysfunction (PFD) can also cause erectile dysfunction, which can further contribute to penile pain. Pain in the penis can also be caused by muscle tension in the pelvic floor muscles. This tension can cause pain or discomfort in the perineum or anus, which can radiate to the penis. Some men with PFD may experience erectile dysfunction, which can cause pain or discomfort during sexual activity.
What does not make sense is how many pelvic floor therapists jump in to address the muscles inside the pelvis when we should be addressing the house (pelvis) that the pelvic floor is the floor of. Without the stability of the pelvis, all the work done internally is pretty much short-lived. This is because what is attached to the pelvis and the joints of the pelvis all become the causing agent of pelvic instability.
What is the Best Treatment for Penis Pain?
While there are some natural treatments that may help alleviate penile pain such as:
  1. Warm compress: Applying a warm compress to the affected area can help relax the muscles and improve blood flow. To make a warm compress, soak a clean cloth in warm water and wring out the excess water. Apply the warm compress to the affected area for 10-15 minutes at a time, several times a day.
  2. Epsom salt bath: Taking a warm bath with Epsom salts can help relax the muscles and alleviate pain. Add 1 to 2 cups of Epsom salts to warm bathwater and soak for 20-30 minutes.
  3. Herbal remedies: Some herbs, such as ginger and turmeric, have anti-inflammatory properties that may help alleviate pain. Drinking ginger tea or taking turmeric supplements may help reduce inflammation and alleviate penile pain.
There are other factors some of which are hardly ever addressed in the world of pelvic floor dysfunction treatment! According to the blog: Is Yoga safe for pelvic floor dysfunction:
  • “Behavior modification which is always part of the solution list to all issues (your behavior about life changes how you do everything in life), is not going to correct any dysfunction fully but addresses some of the feeders of the problem.
  • Postural Neurology: Movement is like a concert and the body parts are like the musicians; in that the musicians not only need to know their part but to know when to chime in and phase out. That means the pelvis and pelvic floor need to know how to ‘play’ with the rest of the body if they are to sustain their strength and integrity. This is what Postural Neurology is all about.
  • Functional Movement: Common sense says that the most authentic way to move is the way babies move. After all, all babies from all over the world go through the same developmental stages of movement (Developmental Kinesiology) which means that we are hard-wired to move that way. So if the issue is movement-related or supported, then we should see how we compare to the way we moved as babies. All discrepancies are then highlighted and can be corrected through Dynamic Neuromuscular Stabilization (DNS) exercises which are baby movements.
  • Kegels? There are machines like the Emsella Chair that do 400 Kegels per minute involving all of the muscles of your pelvic floor and not the ones that you hope to be engaging. Note that Kegel exercises are not for all types of incontinence and pelvic floor muscle issues.
  • Breathing is what babies do automatically and that is what we need to do in order to sustain the bottom of the breathing apparatus, the pelvic floor!
  • Internal manual work which ideally should be done to assess the muscles inside the pelvis BUT does not have to be done in all cases.
  • Nutrition:  Avoid citrus, caffeine, soda, artificial sweeteners, and spicy foods. Take collagen, Vit. C, Vit. D, Omega 3, and protein if no conflict with any other conditions that suggest their avoidance.
  • Ergonomics: Sit on an exercise ball vs a chair. Get a keyboard that is as wide as your shoulders. Limit your sitting to no more than one hour and alternate with standing. Make sure the middle of your monitor is at eye level to name a few.
  • Postural Awareness: It is important to pay attention to your posture and catch yourself when not standing on both feet, slouching, or shifting the pelvis forward in front of the ankles. Best to associate the increase in attention with activities done each day; for instance, when talking to someone pay attention to the feet and pelvis positioning.
  • Sleeping habits: do not sleep on the stomach and if you are a stomach sleeper get a body pillow to minimize that.”

What Activities Cause Penile Pain?

There is no specific activity that causes the most penile dysfunction. Penile dysfunction can have a range of causes, including physical, psychological, and lifestyle factors. Some common physical causes of penile dysfunction include medical conditions such as diabetes, high blood pressure, and heart disease, as well as injuries to the pelvic area. Psychological factors such as stress, anxiety, and depression can also contribute to penile dysfunction.

Lifestyle factors such as smoking, excessive alcohol consumption, and a sedentary lifestyle can also increase the risk of penile dysfunction. It’s important to note that while certain activities or behaviors may increase the risk of penile dysfunction, it is often a complex condition with multiple contributing factors.

 

What Physical Activities Cause Penile Pain the Most?

Penile pain can have a range of causes, and specific activities that cause penile pain may vary depending on the underlying cause. Some common activities that may cause penile pain include sexual activity, particularly if there is vigorous or prolonged friction, or if there is insufficient lubrication. Penile pain may also occur as a result of injuries to the penis, such as trauma or fractures, or as a result of medical conditions such as Peyronie’s disease, which can cause curvature and pain in the penis.

Other activities that can contribute to penile pain include cycling or horseback riding, which can put pressure on the perineum and lead to irritation or compression of nerves and blood vessels in the pelvic area. In some cases, penile pain may be a symptom of pelvic floor dysfunction, which can cause muscle tension or spasms in the pelvic floor muscles, leading to pain or discomfort in the penis or genital area.

If you think you have pelvic floor dysfunction or your treatment has not been satisfactory, do not hesitate to contact me.

Dr. Shakib

Recommended Reading:

Posture and Pelvic Floor Health in Men: Reducing the Risk of Weakness

Managing Pelvic Floor Dysfunction: Top Lifestyle Changes to Improve Symptoms