How Pelvic Floor Physical Therapy Helps Male Pelvic Pain

In Male Pelvic Pain by Tiffany Yuen2 Comments

By Tiffany Yuen, DPT, PHRC Los Gatos


Did you know…


Chronic pelvic pain syndrome (CPPS) has a worldwide prevalence between 2% and 16% and is the most common urologic disease in men below 50 years old (Smith et al., 2016)


Painful ejaculation has a prevalence  between 1% and 10% in the general population, but this may increase to 30% to 75% among men who suffer from CPPS (Parnham et al., 2016) 


One in four patients seeking initial medical treatment  for new onset erectile dysfunction (ED) is younger than 40 years of age with almost half of the young men suffering from severe ED, with comparable rates in older patients (Capogrosso et al., 2013) 


Men with CPPS have more abnormal pelvic floor muscular findings compared with a group of men without pain, which may contribute to the condition (Hetrick et al., 2003) 


Pelvic floor physical therapy, including manual therapy techniques, progressive muscle relaxation, flexibility exercises, and aerobic exercises have been proven to be effective in reducing pain and improving sexual function in patients with CPPS (Van Alstyne et al., 2010) 


Pelvic Floor Dysfunction and Male Pelvic Pain 


Symptom you may experience include: 

  • Pain in the lower back, abdominal, and pelvic area, including the groin, penis, perineum, scrotum/testicles, or rectum 
  • Pain with sitting, restricted clothing, or certain exercises 
  • Dysuria (pain or burning with urination)
  • Increased urgency/frequency of urination
  • Urinary hesitancy (difficulty initiating urine stream) 
  • Urinary intermittency (starting/stopping while urinating) 
  • Urinary retention (incomplete urination) 
  • Nocturia (frequent nighttime urination) 
  • Pain or burning during or after ejaculation 
  • Premature ejaculation 
  • Erectile dysfunction, specifically pain or difficulty with gaining and maintaining erections along with weaker erectile strength 
  • Decreased libido 


Associated diagnoses include: 

  • Chronic pelvic pain syndrome 
  • Chronic nonbacterial prostatitis 
  • Interstitial cystitis/painful bladder syndrome 
  • Pudendal neuralgia 
  • Hard flaccid syndrome 
  • Erectile dysfunction 


Mechanisms for symptom development include: 

  • Surgical trauma, including 
  • Hernia repairs (Nienhuijs et al., 2007)
  • Vasectomy (Morley et al., 2012)
  • Prostatectomy (Scott et al., 2020) 
  • Over Exercising at the gym or biking for prolonged periods of time (Sacco et al., 2010) 
  • Sexually transmitted diseases (Pontari et al., 2013) 
  • Pelvic floor dysfunction (Hetrick et al., 2003) 
  • Stress (Ullrich et al., 2005) 


Diagnostic challenges 

If you are experiencing any of the symptoms listed above, you may have already done an online search for “how to fix/stop male pelvic pain.” It’s also possible that you may have already sought or plan to seek care from your primary care provider or urologist. Your doctor or urologist may have examined you and recommended several diagnostic tests , including urinalyses, urine cultures, imaging, cystoscopy, or urodynamics testing. It’s been several weeks and all the tests come back negative and your doctor tells you your prostate is normal after examining it manually. Your doctor sends you home with multiple rounds of antibiotics, but your pain and symptoms remain the same after the regimen. What do you do now? This is similar to Ben’s situation in his success story.


What is PFPT for male pelvic pain and how can it help? 


Assessment and treatment for male pelvic pain involves an evaluation with a pelvic floor physical therapist. During the first visit, your physical therapist asks you about your history and symptoms, screens your bladder, bowel, and sexual function, and reviews what doctors or specialists you may have seen in the past. During the physical examination, your physical therapist examines your posture and movement patterns as well as assesses the mobility of your connective tissues, muscles, joints, and nerves. After your physical therapist completes the examination, they will review their findings with you and educate you on pelvic floor anatomy as well. Your physical therapist will generate an assessment to propose how your symptoms and pain developed and create both short-term and long-term goals for your treatment plan, which is typically 12-weeks long. Along with in-person visits one to two times a week, you will be given a home exercise program, which will be progressed and modified based on your individual needs. In-person visits will usually consist of checking in with whether your symptoms have changed and performing manual therapy as well as myofascial trigger point release to address any connective tissue or musculature restrictions you may have. Most importantly, your physical therapist will understand that you may feel frustrated by the time you come to see them and will take the time to listen to what you have been going through and acknowledge your symptoms. Feel free to click here to read about a success story and how pelvic floor physical therapy can help with male pelvic pain.


YouTube Videos on Male Pelvic Pain

Penile Pain: Why it Occurs and How Pelvic Floor PT Can Help

Male Pelvic Pain

Erectile Dysfunction

Male Pelvic Pain


Success Stories

Why Does the Area Between My Balls and My Butt Hurt? Tyler’s Male Pelvic Pain Success Story

Male Pelvic Pain Explained: Steve’s Success Story

How to Tackle Pelvic Pain, Joseph’s Success Story

Male Pelvic Pain Explained: Tommy’s Success Story

Prostatitis, pelvic pain, and physical therapy: a case of success!

Young Men Get Pelvic Floor Dysfunction. Here’s How Chris Recovered with Pelvic Floor Physical Therapy!

Additional Blog Resources on Male Pelvic Pain

Chronic Pelvic Pain Syndrome/Male Pelvic Pain/’Prostatitis’ Resource List 



Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

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What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.


  1. Thankfully you are addressing male Pelvic Pain.
    It’s a shame that there are so few PelvicTherapists who treats men.
    I am frustrated and have found several “Therapists “ who claim to treat men but are wholly incompetent in treating us.
    Please learn to treat men!

    1. Sean,
      We are sorry to hear you’ve had trouble finding physical therapists who treat men. We are glad to have put this blog out for you to know that there are PTs out there who do treat me!

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