Pelvic Health for Men & Penis Owners

Penis owners have pelvic floors too.

Physiotherapists are trained to assess and treat pain and musculoskeletal issues which includes muscles, joints, nerves and connective tissues. Issues that can arise in the pelvic area as a result of poor muscle, nerve or joint function:

• urinary incontinence, urgency or frequency

• fecal incontinence

• chronic constipation

• chronic pelvic pain syndrome (previously known as chronic non-bacterial prostatitis)

• hard flaccid syndrome

• hernia

• anorectal pain

• pelvic pain

• Peyronie’s disease

• tailbone (coccyx) pain

• urinary retention

• erectile dysfunction

• sexual dysfunction (eg. pain with orgasm or ejaculation, pre-mature ejaculation)

During the course of rehabilitation, it may be beneficial for the provider to examine and treat the pelvic area. Please note that only physiotherapists with training in genito-pelvic conditions are qualified to directly assess and treat the genitals and pelvic floor area. This may include direct examination of the genitals (i.e. the scrotum and/or penis) or a digital rectal exam. Draping (covering) of sensitive areas will be maintained in place throughout the session and ONLY removed if/when necessary and with consent for examination and treatment purposes. The goal of examination/treatment of these areas is to help determine where the pain/symptoms are originating from or to address pain/symptoms with tissue mobilization techniques. Pelvic rehabilitation is NOT a sexual therapy and is not meant to be experienced as sexual in nature.

Situations in which assessment/treatment will not be completed:

• lack of consent: assessment and treatment techniques will always be discussed and you will be provided with options of whether or not you’d consent to participate. You may withdraw consent at any time.

• if an active infection is present (eg. STI, UTI)

• active rectal bleeding

• active seed implants (for radiation treatment in some types of cancers)

• if you’ve had surgery to the pelvic area < 6 weeks ago or have not been cleared by your physician following surgery

• if the therapist or patient does not feel comfortable proceeding

**Given the sensitive nature of pelvic topics, clear communication with your therapist is vital. If it is not clear for what purpose certain questions are being asked, or if you are unsure of the meaning of certain terminology, you are encouraged to ask for clarification. You are also encouraged to speak up to the best of your ability if any part of the examination or treatment process is uncomfortable in any way (eg. physically, psychologically etc.). Similarly, if your therapist is not feeling comfortable with the conversation or any components of how the session is going (eg. sexually suggestive comments or questions), they will communicate their discomfort with you and give an opportunity to redirect the conversation. Continuing to make the provider feel uncomfortable may result in discontinuation of services. The goal of pelvic rehabilitation is to provide a safe environment for both you and your healthcare provider in a way that keeps your dignity and therapeutic goals in mind.

Discontinuation of services

There may be situations in which treatment will be suspended or a patient will be asked not to book a follow-up session before a course of treatment is completed. This may occur if the patient has broken professional boundaries as discussed with the therapist and outlined above.

Examples of breaking professional boundaries include:

• asking about the therapists relationship status or sexual health

• sexually suggestive comments, jokes or questions

• requesting specific and suggestive techniques or practices that are not within the therapists scope of practice or beneficial to the treatment plan (eg. prostate milking).

In the event that a boundary is crossed, the physiotherapist will take the following steps:

• verbally identify the inappropriate behaviour to the patient directly

• explain/clarify why the behaviour is inappropriate and problematic for the clinical setting

• As per our College standards, the physiotherapist may choose to discontinue care moving forward should the patient continue to breaking the professional boundary and all reasonable steps have been taken to manage the behaviour. Treatment will also be terminated if the therapist believes the patient will become abusive.

Frequently Asked Questions:

Q. I’m worried that I might get an erection during treatment. Is this a problem? What happens if I do?

While it doesn’t happen often, it may occasionally occur as these tissues are designed to respond to touch with increased blood flow. The therapist is aware that an erection does not always mean intended arousal. Should this situation occur, the therapist will pause assessment or treatment until increased blood flow has resolved. When both you and the therapist are feeling comfortable and safe to proceed, treatment can resume as appropriate. If this is a continual issue, the techniques or treatment approach can be modified to avoid unwanted situations.

Q. My partner is worried that a therapist will be touching me in a sexual way.

Occasionally, partners have concerns about a therapist working so directly with this area of the body and for very personal issues (eg. erectile dysfunction, penile pain etc.). Physiotherapy is NOT a sexual therapy and any assessment, treatment or direct touch to sensitive areas are always conducted professionally, with consent, and with the sole purpose of improving pain, tissue mobility, and function. All relevant anatomy, physiology and reasoning for working on or near the genitals will be explained prior to your assessment or treatment and opportunity for questions or concerns will be provided. If it is preferable to you and your partner, they are welcome to attend physiotherapy sessions and can be taught ways to help you complete rehab work at home in between appointments.

Q. Do you massage the penis to see if there is improved blood flow or erectile improvement after treatment?

Never. Any comparison of function is to be tested on the patients own time, not in the clinic. The patient can report back general findings as they pertain to treatment and therapeutic goals. Massage for this purpose is not appropriate and requesting such services may result in termination of treatment without an option to rebook in the future.

Q. Do I have to talk about personal, private or embarrassing things with my provider?

Typically, questions pertaining to sexual function, bowel and bladder habits as well as skin changes are routinely asked as a way to gain information that gives insights into what may be causing your symptoms. While more complete answers provide us with more comprehensive insights, you are always encouraged to discuss only those topics with which you feel safe in disclosing. Should you become more comfortable to disclose certain information down the road, you are always welcome to offer that information up at a future appointment.

Content ideas and FAQ topics from Holly Tanner, PT