Male Pelvic Pain: What You Need To Know

3 min read

Male Pelvic Pain: What You Need To Know

Imagine for a moment the worst splitting headache that you have ever experienced. Envision that same intensity of pain, now located between your legs - and instead of lasting for a few hours, this excruciating pain lasts for months at a time. The pain pulsates through your pelvis, impacting your sexual, urinary, and bowel function and is so disruptive that you cannot easily go about your daily life. Thousands of men experience this type of pain every day. Unfortunately, it is often improperly diagnosed and, more frequently, improperly treated. The condition is known as tension myalgia of the pelvic floor muscles and there are ways to prevent and reverse it.


This condition is commonly misdiagnosed as “chronic prostatitis,” with the prostate gland being blamed as the source of the pain. However, ninety-five percent of men diagnosed with “chronic prostatitis” do not have an infected or inflamed prostate gland.


What many actually have is a condition called tension myalgia, which causes the pelvic floor muscles to tighten, spasm and over-contract. The pelvic floor muscles feel as if they are tied in a “knot,” creating a severe “Charlie horse” of the pelvis. Characteristically, the pain varies in intensity over time and wanders to different locations in the pelvis, possibly involving the lower abdomen, groin, pubic area, penis, scrotum, testicles, perineum, anus, rectum, hips and lower back.


Tension myalgia of the pelvic muscles can be brought on by anxiety, stress, and other circumstances and is thought to be an abnormality with the nerve pathway that regulates muscle tone.


Patients who have tension myalgia of the pelvic muscles often have difficulty in expressing their precise symptoms, although they usually have a long list of issues, lots of prior treatments, and have seen many doctors. The pain is often described as “stabbing” in quality and can be triggered by urination, bowel movements, sexual activity/ejaculation, driving a car or wearing tight clothing.


Conventional urology has a very nuts-and-bolts mechanical focus and has been slow to accept that stress and other psychological factors can give rise to physical conditions such as tension myalgia.


There are several ways to prevent and reverse the effects of tension myalgia:

1. Relaxation, Stretching & Physical Therapy. It is necessary to relax the spastic pelvic floor muscles and there are a variety of means of doing so, including relaxation techniques, stretching, hot baths, massage, and muscle relaxants. Many respond nicely to physical therapy sessions with skilled pelvic physical therapists capable of trigger point therapy, which involves compressing and massaging the spastic pelvic muscles.

2. Internal Trigger Point Release. Those who are so motivated can treat themselves with a therapeutic internal trigger point release rectal wand that aims to eliminate/mitigate the knots. This treatment is referred to as the Stanford pelvic pain protocol or alternatively, the Wise-Anderson protocol (designed by David Wise, a psychologist, Rodney Anderson, a urologist, and Tim Sawyer, a physiotherapist). For a wonderful reference, consult Dr. Wise and Anderson’s book, A Headache in the Pelvis: A New Understanding and Treatment for Chronic Pelvic Pain Syndromes.

3. Pelvic Muscle Exercises. When used carefully, pelvic floor muscle training programs can be beneficial to pelvic floor muscle tension myalgia. A good program(aside from the emphasis on strength training of the pelvic floor muscles) serves to instill awareness of and develop proficiency in relaxing the pelvic muscles as one cycles through contraction and relaxation. The principle is that maximal muscle contraction induces maximal muscle relaxation, a “meditative” state between muscle contractions.

One must be cautious in contracting muscles that are already spastic and hyper-contractile, as pain can potentially be aggravated by such activity. The Private Gym Basic Training program, available at, promotes mindfulness of the pelvic floor muscles and the skill set to help “untie” the pelvic floor knot. Men without pelvic pain can also benefit from the Private Gym by strengthening pelvic muscles and reducing the risk of developing painful conditions such as tension myalgia.

Andrew Siegel, M.D., Urologist, Cofounder of The Private Gym, and author of the highly acclaimed book, Male Pelvic Fitness, Optimizing Your Sexual and Urinary Health.

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