Mens health – issues in the bathroom or the bedroom?

by Pelvic health physio Danae

The last few years have seen a spotlight shon on areas of womens healthcare. But for most men with pelvic pain or dysfunction, their needs are still left in the dark. Erectile dysfunction, chronic pain, incontinence or problems with toileting aren’t the typical topics of conversation around the pub. So where do you go? Who do you talk to? 

Your GP can be a great start. They can screen for medical causes, rule out underlying pathologies and refer on to specialists if needed. But what else? For an overwhelming number of men, seeing an experienced pelvic floor physio can help improve their function, address symptoms and restore confidence. Here’s some common conditions that can be effectively treated with the help of your pelvic floor physiotherapist.

Erectile dysfunction (ED) 

It’s a problem that affects over 1 million Aussie men, and around half of those aged 40 to 70 years. Whether it’s the inability to achieve or maintain an erection, diminished sexual function can be a real source of distress for men both individually and in their relationships. ED is not a disease, but rather a symptom of underlying issues. These can be physical, psychological or a combination of both.

Some physical contributors include:

poor vascular health and circulation issues (e.g. diabetes, high blood pressure/cholesterol, smoking, sleep apnoea, obesity)

nerve deficits or tissue dysfunction (post pelvic/prostate surgery, trauma, Parkinson’s disease, Peyronie’s disease)

hormonal issues (e.g. lack of testosterone, excess cortisol (stress hormone))

Psychologically, any issues around sexual arousal and performance (however minor) can be exacerbated by feelings of stress and anxiety. To treat one cause and not address the others would be an ineffective approach to management. For this reason, your pelvic floor physio will assess your pelvic floor muscles and tailor a program to improve their function. The evidence shows that men with strong pelvic floor muscles have better erectile function. But also – and just as importantly – they will assess and discuss your approach to sex. Understanding feelings of worry, angst or apprehension around performance is a critical step towards improving it. 

Pelvic Pain

Longstanding, chronic pain can be physically and emotionally distressing. This can feel compounded for men, with the lack of tailored information and resources available when they go looking for help. Pain in or around the pelvis can lead to nearby muscles (inside and out) becoming tight and overactive, resulting in issues around sex and toileting and even just sitting. But what causes it? 

Well, the body is very good at protecting itself – self preservation is critical for survival. But sometimes the brain’s ability to judge a true threat from a ‘normal’ message can be confused, and a person’s whole system (brain and neural pathways) can be hyper-sensitised to any and all messages. Especially when those messages are coming from the same area. It’s as if your car alarm goes off not just when someone attempts to break in… but also when a leaf falls on the roof. 

Imagine you experience a bout of constipation, or pain with ejaculation. Your brain is clever, remembering this event so as to better protect against it next time. Overtime the brain learns that it can make the body brace or guard itself (muscles tensing, breath holding and other avoidance patterns) to avoid a repeat of the painful event. Over time, this can lead to certain muscle groups such as the pelvic floor becoming overactive and unable to properly coordinate for toileting and sexual performance. Knowing this, it’s no wonder the best treatment is a multimodal approach.

It’s not as simple as just “letting go” or “stop being so tense”.  Your pelvic floor physio can perform/teach you physical release and relaxation techniques that help reduce muscle tension and pain. Reminding those muscles that it’s safe to let go, and retraining their correct motor patterns helps optimise toileting and restore sexual function. In addition, we need to look at the whole person – what sources of stress, anxiety or lifestyle factors are contributing to the problem? Your physio can help individualise strategies of mindfulness and exercise to better manage these, both now and in the longterm.

Lower Urinary Tract Symptoms (LUTS)

If you’re over 70, you have a one in three chance of experiencing moderate to severe lower urinary tract symptoms (LUTS). These could be any issues relating to the bladder, urethra or prostate, including:

bladder frequency or urgency


weak or interrupted stream

straining to empty

post-void dribbling

nocturia (getting up two or more times a night to empty)

incontinence (leaking)

While it’s often dubbed an “old man’s” problem, we know as many as one in 14 are affected in their 40s or younger. And as much as it may be common, LUTS is never normal and should never be accepted simply as ‘part of life’.  A visit to your doctor can help identify possible causes such as diabetes, hypertension, obesity, sleep apnoea, smoking or obesity. Prostate screening, medication checks and ruling out infection or obstruction is also a must.  But what can YOU do?

Your Vital Core pelvic floor physio can help you take a proactive approach – starting with bladder retraining and improving fluid habits. Showing you how to optimise pelvic floor muscle function and correct toileting techniques are great, effective ways to take back control. You’ve got better things to do than be in the bathroom all day and night, right?!


Strong links between all three conditions (pain, ED and LUTS) are well documented, making things often seem worse and more permanent than they are. For many men with pelvic health issues, their quality of life is diminished and the right kind of help may not seem easily accessible. While causes are often many and rarely isolated, education and treatment is available.  If you want to know more or ask about any of your symptoms, make a time to see our Vital Core pelvic floor physios today. You shouldn’t be embarrassed, it is very common and it can be managed effectively.