By Elizabeth Akincilar, MPT, Cofounder, PHRC Merrimack
Over the last couple of years PHRC has shared many YouTube videos and educational material on Instagram educating our viewers and readers about pelvic health. We have received an overwhelming response to several of our posts discussing male pelvic pain, in particular penile pain. Listed below are some of the most common questions we’ve received and our answers. A video Q&A can also be found on our YouTube channel.
Q: I began to feel pain in the muscles around the penis after having an erection for an unusually long time. What do you suggest?
A: In order to maintain an erection, in part, certain muscles in the pelvic floor have to sustain a contraction. Therefore, if an erection is maintained for a particularly long time the muscles that have to contract may have difficulty relaxing, which can lead to discomfort. A similar example is if you make a fist and hold that fist for as long as you can. When you relax your hand you will have difficulty fully relaxing your hand and the muscles in your hand will likely be sore for a short period of time. Most likely, if your pelvic floor muscles are allowed to relax and not be challenged again soon (with a sustained erection) the discomfort you feel will resolve. If it does not resolve I would recommend that you consult with a pelvic floor physical therapist as you may have underlying pelvic floor dysfunction that needs to be addressed with treatment.
Q: Can overstretching the penile branch of the pudendal nerve heal itself over time?
A: The pudendal nerve can heal, but that is dependent on many factors, for example, is it still being irritated or compressed by activities, behaviors and/or anatomic anomalies? If it is, it will not heal with time alone. This is a question that is very specific to the individual and would need to be evaluated and discussed with a medical professional that specifically treats pudendal neuralgia.
Q: You mentioned two muscles that the dorsal branch of the pudendal nerve runs through and how their impairment or dysfunction might irritate the nerve. Which two muscles are these and how can they be relaxed?
A: The two muscles that surround the dorsal branch of the pudendal nerve are the bulbospongiosus and the ischiocavernosus. They can be relaxed two ways. One way is with manual therapy which would include techniques to stretch these muscles directly or to eliminate myofascial trigger points in the muscles, if they exist. You can also utilize dry needling to eliminate myofascial trigger points in these muscles. The other way is to practice relaxing your pelvic floor muscles. There are certain positions that can facilitate pelvic floor relaxation such as the yoga pose happy baby combined with diaphragmatic breathing. Ultimately, consulting with a pelvic floor physical therapist would be best as they would be able to utilize these manual techniques as well as teach you how to most effectively relax your pelvic floor.
Q: Are antibiotics a cure for nerve damage? My doctor has tested me for infections and stds and everything is negative.
A: No, antibiotics are not a treatment for nerve pain. Antibiotics are only an appropriate treatment when there is a bacterial infection. If your physician has ruled out all causes for your penile pain it would likely be beneficial to consult with a pelvic floor physical therapist.
Q: Does pelvic floor physical therapy help when the penile branch of the pudendal nerve is damaged? I have seen numerous doctors who don’t find anything on CT scans or visual examinations. I was recommended to go to physical therapy, should I?
A: Pelvic floor physical therapy can treat the surrounding structures (tissue, muscles, etc) that can be contributing to nerve irritation. Therefore, PT can facilitate nerve healing by creating an environment around the nerve to lessen nerve irritation. If your physicians have ruled out other causes for your pain, an evaluation with a pelvic floor physical therapist is recommended.
Q: What should a man expect during his first visit for this pain?
A: You can refer to these blogs as what to expect in a pelvic floor physical therapy initial evaluation and how it can help male pelvic pain.
What a Good Pelvic PT Session is Like (two parts)
How Pelvic Floor PT Helps Men’s Health
How Pelvic Floor Physical Therapy Helps Male Pelvic Pain
Q: The right side of my penis is numb and I am not able to orgasm. Could this be due to a pelvic nerve problem?
A: Yes, it is possible that the right penile branch of the pudendal nerve is involved. I would consult with a urologist first. If they are unable to find a cause for your pain I would recommend consulting with a pelvic floor physical therapist.
Q: What is jelqing and why is it bad to do?
A: Jelqing is a technique that manually lengthens or stretches the penis with the intention of adding length to the penis or making the penis look larger. Although this practice has gotten a lot of attention online, there is no scientific evidence that this technique actually results in an enlargement of the penis. This process can put too much tension or stretch on the penis and therefore the penile branch of the pudendal nerve. When a nerve is excessively stretched the nerve can become irritated and can cause pain, or in extreme cases, it can damage the nerve causing numbness and motor loss such as erectile dysfunction.
Q: Is pain with an erection part of hard-flaccid syndrome?
A: It is not the most common symptom, but it can be a symptom of hard-flaccid syndrome.
Q: I sit for long periods of time for work; can this contribute to penile pain and should I be worried about sitting for that long?
A: Yes, sitting for extended periods of time can contribute to pelvic pain, including penile pain. If you need to sit for long periods of time try to get up every 30 minutes and walk around for five minutes, or, get a sit/stand desk and go back and forth between sitting and standing every 30 minutes. If you’re unable to do either of these things, consider using a pressure relieving cushion that distributes your weight while sitting more evenly, or a cushion that has a cut out in the middle to provide pressure relief to the genitals in particular. Check out this video for more information on cushions.
Q: I felt more pain after heavy exercise…is this normal? Squats are a big part of my exercise routine and I am concerned I will have to stop doing them because of the pain.
A: When we squat the pudendal nerve slides around a small bone in the pelvis called the ischial spine. If the nerve is already irritated, this movement can further irritate the nerve. Therefore, repetitive squats can further irritate the pudendal nerve with each repetition. Additionally, we contract many muscles during a squat, including the obturator internus and the pelvic floor muscles. If these muscles are dysfunctional, squats could exacerbate their dysfunction and cause more pain. There are many different exercises that strengthen the muscles in the lower body that do not involve squatting. If you have increased pain with squatting exercises you should speak to your physical therapist about alternative exercises.
Educating the community about pelvic health continues to be one of PHRC’s primary goals. Please remember that our educational material does not replace a comprehensive evaluation by a healthcare professional. If possible, an in-person comprehensive evaluation by a healthcare professional is always recommended to address your pelvic health concerns appropriately.
If you would like, you can schedule a virtual appointment with one of our experts.
If you would like more information about PHRC, email us a message and we’ll get back to you asap!
If you would like to schedule an in-person evaluation, please call the PHRC location that is most convenient for you.
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Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
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.
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FAQ
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.