Male Pelvic Pain Physical Therapy in San Francisco, CA

Men have a 10% chance of developing pelvic floor dysfunction throughout their life. These symptoms are commonly misdiagnosed, however, leading doctors to believe prostatitis is the cause. This misdiagnosis causes unnecessary antibiotic prescriptions and a delay in the treatment process. Antibiotics are often prescribed multiple times before realizing that pelvic floor physical therapy is the answer.


  • Pelvic pain generally refers to burning, itching, aching, or other types of pain in the penis, scrotum, testicles, perineal, and/or anal area
  • Men suffering from pelvic pain often have pain with sitting, certain types of exercises, and certain types of clothing
  • In addition to pelvic pain, men often experience urinary urgency/frequency/hesitancy and pain and slower/diminished urinary stream
  • Ejaculation can cause penile, scrotal, or perineal pain
  • Men may experience erectile dysfunction and decreased force of ejaculate
  • Men may suffer from gastrointestinal distress, bloating, and/or constipation
  • Symptoms can be provoked, such as in response to ejaculation or exercise, or unprovoked and spontaneous
  • Symptoms may be intermittent or constant

Associated Diagnoses

Chronic Pelvic Pain Syndrome/Male Pelvic Pain, Chronic Nonbacterial Prostatitis, Pudendal Neuralgia, Hard Flaccid Syndrome, and Interstitial Cystitis/Painful Bladder Syndrome are all pain syndromes that cause pelvic pain due to pelvic floor dysfunction.

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Causes of Pelvic Pain

  • Surgical trauma (vasectomy, benign prostatic hyperplasia (BPH) interventions, prostatectomy)
  • Orthopedic injuries or other traumas (spine, hip, knee, and/or ankle injuries/pathology, accidents)
  • Biomechanical or structural dysfunction (hip dysfunction, piriformis syndrome, scoliosis, leg length discrepancy)
  • Excessive exercise or changes to exercise routine
  • Excessive sitting
  • Chronic constipation and straining
  • Jelqing and/or attempts at genital enhancement or foreskin regeneration
  • In rare cases, bladder, prostate, or sexually transmitted infections after successful resolution of infection
  • The majority of men with pelvic pain, with or without urinary or bowel complaints, have pelvic floor dysfunction

Diagnostic Challenges

Studies show that men with pelvic floor dysfunction may be waiting up to seven years for a proper diagnosis. This procrastination is because pelvic floor dysfunction impersonates certain types of infections. Because testing for prostate infections is a laborious process for the patient and the medical provider, most urologists empirically prescribe antibiotics without testing. The majority of medical providers are also unaware that men can suffer from pelvic floor dysfunction. To complicate the matter further, many pelvic floor physical therapists are only trained to treat women. This is not the case at PHRC, in fact, some days we treat more men than women.

Even though they may never have an infection, men are almost always pushed out of the office with antibiotics. Research shows that over 90% of men with genitourinary symptoms of pelvic pain do NOT have a prostate infection and fall into the National Institutes of Health Classification of prostatitis syndromes categories IIIa and IIIb, Chronic Pelvic Pain Syndrome (CPPS).

The National Institute of Health Classification of prostatitis syndromes are:

Category I

Acute bacterial prostatitis which is associated with severe prostatitis symptoms, systemic infection, and acute bacterial urinary tract infection.

Category II

Chronic bacterial prostatitis which is caused by chronic bacterial infection of the prostate with or without prostatitis symptoms and usually with recurrent urinary tract infections caused by the same bacterial strain

Category IIIa

Inflammatory chronic pelvic pain syndrome (white blood cells in semen and/or expressed prostatic secretions and/or third midstream bladder specimen)

Category IIIb

Noninflammatory chronic pelvic pain syndrome (no white blood cells in semen and/or expressed prostatic secretions)

Category IV

Asymptomatic inflammatory prostatitis which is categorized by prostate inflammation in the absence of genitourinary tract symptoms

How We Can Help You

Men experiencing pelvic pain can benefit from an evaluation with a pelvic floor physical therapist specializing in pelvic pain. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone, and how effective or not effective these treatments have been. Importantly, we understand what you have been going through and that most men are frustrated by the time they get to see us. During the physical examination, the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once your physical therapist completes the exam they review your findings with you. The physical therapist creates an assessment that explains how you developed pain and fabricates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. You are given a home exercise program to complement your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life!

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