Male Pelvic Pain PT Patient: Should I Masturbate during Healing?

In Male Pelvic Pain by Stephanie Prendergast8 Comments

Had Fourth-Degree Tear after Delivery: How Can I Help Myself Heal?

…Should I have the Pudendal Nerve Decompression Surgery?

…Can Yoga Help Strengthen my Pelvic Floor?

These are the reader questions we will be answering in this Q&A blog post! So read on, and if you have any questions of your own, ask away in the comment section or shoot us an email at:blog@pelvicpainrehab.com.

Does Masturbation make male pelvic pain worse?

Dear Liz,

I’m a 30-year old man who’s been dealing with pelvic pain for the last two years. I have penile pain, perineum pain, and numbness throughout my lower back, pelvis and legs. I have been in PT for nearly eight months and have seen great gains. In fact, the numbness I had experienced is nearly completely gone.

One thing that continues to frustrate me is that after ejaculation, I get a recurrence of symptoms in my perineum from my scrotum to my tailbone and into my legs and back, which then takes time to calm down and dissipate. Should I keep masturbating while in treatment or should I stop until I reach a certain level in my treatment?

Dear Reader,

For men, pain during masturbation is commonly due to trigger points in the ischiocavernosus and/or bulbospongiosus. If that is the case with you (and I would ask your PT) then masturbating could worsen those trigger points or interfere with the process of releasing them. But here’s the rub, as a general rule, I never tell my patients to discontinue sexual activity. Because the fact is, the benefits can and often do outweigh any negatives. For instance, the intimacy that is gained with sex with a partner; the release of stress that masturbation can achieve; and the overall endorphin rush that sex produces all have benefits that can help someone dealing with a chronic pain issue. So, it really is a personal decision for you to make: whether the benefit you get from sexual activity is worth slowing down your healing. Or whether taking a break until you’ve reached your goal in PT is something you can do. For my part, as a PT, I will never tell my patients to discontinue sexual activity.

All my best,

Liz

How Can PT Help my Pantyline Scar Pain?

Dear Liz,

I had a cyst removed along my panty line. (Near the ligament that runs from my pelvis to my femur. The scar tissue (identified by my doctor) feels like it runs deep into the skin going into the ligament. I have to be very careful of what underwear I wear because it hurts if there is too much pressure there. How can I get PT for that sensitive area or what can I do at home?

Dear Reader,

It’s likely that the reason your skin is hypersensitive in that area is scar tissue and dysfunctional connective tissue. A PT can manipulate this tissue to normalize the connective tissue mobility as well as minimize scar tissue. This should dramatically decrease your sensitivity. At home, don’t be afraid to touch, move, and massage that tissue often, even if it hurts.

All my best,

Liz

Had Fourth-Degree Tear after Delivery: How Can I Help Myself Heal?

Dear Marcy,

I delivered vaginally three weeks back and ended up with a fourth degree tear extending from my vagina to my anus, and multiple second-degree tears. So far stitches are healing well. But I continue to have soreness and tenderness in the area. The pulling sensation with every movement is very uncomfortable and I just catch a break. I am scared. And don’t want to live with this pain. I hear that it may cause painful sex, incontinence and pelvic organ prolapse.

How can I help my body to heal completely and possibly prevent future complications? How can I ease the discomfort? Are there any activities that I shouldn’t do or should do?

Dear Reader,

You had some significant trauma to your perineum. Three weeks is still very soon post- partum to really be able to tell what’s going on. You are still healing, and it takes at least 6-8 weeks for normal tissue healing. You will feel the tightness in your perineum and at the scar site for some time, but it will get better as you heal. I would say it would be a really good idea to see a pelvic floor physical therapist as soon as you are cleared for internal work. In the meantime, just rest, take it easy, try to sleep as much as you can, and let your body heal. Sometimes sitting on an ice pack helps, and try to avoid pushing or straining to evacuate your bowels. Your MD may recommend a stool softener, so BMs are a little less painful and easier to pass. Hang in there, and I would say go to PT when you are ready.

All my best,

Marcy

Should I have the Nerve Decompression Surgery?

Dear Stephanie,

I have many of the symptoms that you describe in your blog post about PN. My symptoms started immediately after a hysterectomy. My question to you is should I should I request to have a decompression surgery or just see if the Cymbalta will help?

Dear Reader,

Cymbalta sounds like a reasonable treatment option, however, your case needs to be managed with a multidisciplinary approach and at this point I would not consider you a good surgical candidate. You have so many options available for you to try before resorting to surgery. Your treatment plan should consist of physical therapy, appropriate pharmaceuticals, and possibly medical intervention, such as nerve blocks and myofascial trigger point injections, and possibly Botox. Your team needs to work with you to differentially diagnosis which structures are causing your pain and come up with a strategy to eradicate the problems.

Can Yoga Strengthen my Pelvic Floor? 

Dear Liz,

Why would doing yoga NOT cause good pelvic muscle strength? Since yoga also primarily focuses on deep breathing, I would assume that the relaxation of the pelvic floor as well as activation of the core would enhance strength.

Dear Reader,

Yoga could absolutely contribute to pelvic floor strength in a person that has normal tone in their pelvic floor. In a person who has a tight or hypertonic pelvic floor yoga could exacerbate that hypertonus because of all the core strengthening. Increasing abdominal pressure, as one does with core strengthening, will increase pelvic floor muscle tone.  However, the deep breathing in yoga definitely helps to relax the pelvic floor musculature.

Comments

  1. You mention that yoga may exacerbate a tight pelvic floor. Would Tai Chi have a similar. effect? Besides specific pelvic floor exercises, are there any exercise classes ot popular types of exercise that would not aggravate a tight pelvic floor? Thanks

    1. Author

      Dear Bob,

      Tai Chi may exacerbate the pelvic floor muscles. Exercise that involves contracting the ‘core’ muscles often causes a pelvic floor contraction as well. A general rule of thumb is that if the exercise in questions creates more symptoms it is probably not a good choice.

      All my best,
      Stephanie

  2. Dear Liz,
    During sex I sometimes get a pain between my balls and anus, and it can make me lose my erection.
    I also sometimes get a pain in my lower back after I ejaculate which lasts a few seconds, should I go see a doctor?

    Thanks

    1. Author

      Dear Dominic,

      I would recommend that you see a doctor; however, if your pain is musculokeletal in nature than a physician may not be aware that PT can help, so I would also recommend seeing a pelvic floor PT; where are you located, perhaps we could recommend one to you in your area?

      All my best,
      Liz

  3. I am having stress fracture
    On my pubic
    Pubic symphysis
    Is it ok to masturbate
    While healing

    1. Author Liz Akincilar says:

      “Hi Aaryan,

      If you have an actual fracture in your pubic bone, I would be careful with masturbating until the fracture heals. Hope this helps!”

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