Cis-Male Sexual Function and the Pelvic Floor
Cis-male sexual function and the pelvic floor are not topics that men are often uncomfortable discussing with their health care practitioner. However, it is a very prevalent concern with 20-30% of adult men having at least one sexual dysfunction (Lewis et al 2010). Examples of sexual dysfunction may include early ejaculation, erectile difficulties, lack of sexual interest, delayed ejaculation, inability to reach orgasm, and pain during sex. This post will describe the physiological process of male sexual function, and what role the pelvic floor plays.
An erection may be initiated as psychogenic (thoughts) or a reflexogenic (touch to or around the genitals). This touch activates sensory fibres of the pudendal nerve which travel up to segments in the sacral region of the spinal cord (S2/3/4). The signal is transmitted from the spinal cord to travel through the motor neurons of pudendal nerve. The motor nerves of the pudendal nerve innervate the superficial pelvic floor muscles called bulbospongiosus and ischiocavernosus. These muscles play a role in initiating and maintaining an erection.
In addition, parasympathetic nerve plexuses are also activated which results in the release of nitric oxide. This hormone dilates the arteries that supply the penis which allows the erectile tissues to fill with blood. As these tissues expand, it creates pressure on the veins, and therefore preventing loss of blood from the penis.
During ejaculation, the sympathetic nervous system takes over. It causes contraction of the smooth muscle in the vas deferens, seminal vesicle and prostate. In addition, the bulbospongiosus and ischiocavernosus contract rhythmically during ejaculation.
What is the role of the Pelvic Floor?
The bulbospongiosus and ischiocavernosus muscles are part of the superficial layer of the pelvic floor. These muscles support an erection by physically lifting the penis and keeping blood in the penis. These muscles may hypotonic meaning they are underactive and weak. This is a common finding in older men dealing with erectile dysfunction and difficulty reaching orgasm. Alternatively, these muscles may be hypertonic meaning that are overactive and weak. In this case, the muscles would have decreased coordination and difficulty relaxing. This is often seen in younger men presenting with early ejaculation and pain with sex.
Keep in mind that these are generalizations. While they are common clinical findings, every patent is unique and may not follow this pattern. Based on your assessment, your physical therapist will prescribe you an rehab program to address your symptoms and objective findings. Some aspects of treatment may include breathing techniques, stretches, external fascial techniques, and/or an internal pelvic floor exam. If you are struggling with concerns around male sexual function and pelvic floor issues, contact us, we would be happy to help.
Lewis, R. W., Fugl-Meyer, K. S., Corona, G., Hayes, R. D., Laumann, E. O., Moreira Jr, E. D., … & Segraves, T. (2010). Definitions/epidemiology/risk factors for sexual dysfunction. The journal of sexual medicine, 7(4), 1598-1607.
LeVay, S., & Baldwin, J. (2012). Men’s bodies. In Human sexuality (4th ed., pp. 86-116). Sunderland, MA: Sinauer Associates, Inc.