Why Is a Weak Pelvic Floor a Major Problem?

The relationship between male sexual function, pelvic floor function, and pelvic pain is complex and only beginning to be appreciated (Source: Cohen, Gonzalez, Goldstein. The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain Sexual Medicine Reviews, Volume 4, Issue 1, January 2016, Pages 53-62)

Sexual dysfunctions are multifactorial and can be caused by a variety of psychological and biologic issues. As it concerns male sexual dysfunctions, most of the sexual medicine research regarding biologic factors has focused on hormonal, neurologic, and/or vascular issues. There has been a dearth of sexual medicine research on the biologic contribution of pelvic floor disorders to various male sexual dysfunctions. This is in sharp contrast to the large number of studies that have linked pelvic floor disorders in women to female sexual dysfunctions. In fact, pelvic floor therapy is one of several suggested sexual medicine strategies to successfully manage female sexual dysfunctions (Source: . Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol 2012; 30:437.)

Despite pelvic floor physical therapy representing a conservative, modifiable, noninvasive, nonpharmacologic, and nonsurgical intervention in the treatment of male sexual dysfunction, the biologic relationship between pelvic floor function and male sexual function is seldom emphasized (Source: 5. Lin YH, Yu TJ, Lin VC, Wang HP, Lu K. Effects of early pelvicfloor muscle exercise for sexual dysfunction in radical prostatectomy recipients. Cancer Nurs 2012; 35:106.)

Male pelvic floor dysfunction has been associated with erectile dysfunction as well as dysfunction of ejaculation and orgasm. Male pelvic floor muscle training has been shown to increase penile rigidity and penile hardness in some men with erectile dysfunction (Source: Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sex Med 2007; 4:4.)

As we discussed in a prior post (How do Erections Work?):

“An erection begins with sensory and mental stimulation. During sexual arousal, nerve messages begin to stimulate the penis. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand and creating an erection.”

and

“As it relates to the pelvic floor muscles (here is a detailed post on pelvic floor muscles), erection is caused by contraction of the ischiocavernosus muscle, which compresses the penis against the ischium (the curved bone forming the base of each half of the pelvis), obstructing the blood flow through the dorsal veins.”

As such, a weak pelvic floor makes it hard to get and maintain an erection.

Additionally, as we covered in How does Ejaculation Work, ejaculation is caused by involuntary contraction of the bulbospongiosus muscle. As such, with a weak pelvic floor, you don’t have the necessary muscular control to prevent the involuntary muscle spasms and resulting ejaculation.

In conclusion, weak pelvic floor muscles usually result in both erectile dysfunction and premature ejaculation since weak pelvic floor muscles contribute greatly to these disorders.