A Tale of Two Men And Their Pelvic Pain

Persistent Pelvic Pain Syndrome (PPPS) is a debilitating condition that has a huge negative impact on men’s physical, emotional and social health and wellbeing. It is more common than you think, with a study reporting 8% of Australian men identify as having pelvic pain.  It is particularly distressing as many of the things men take for granted – sitting, walking, exercising, urinating, defaecating, sexual arousal and ejaculation - can cause crippling, agonising pain. 
Pelvic pain can be anywhere in the pelvis, from the low abdomen to the penis, scrotum, perineum, bowel and low back. Here we share the journey of two of our patients experiencing pelvic pain and how Pelvic Health Physiotherapy supported them to get their life back.

Meet Geoff and Luca

Geoff is a 40-year-old project manager who shared a long history of tension and pain in his pelvis that commenced 10 years ago. He developed testicular pain in 2017 which gradually worsened and was now constant in his perineal, anal and scrotal area.  He was also experiencing erectile dysfunction and straining to empty his bladder. He was understandably miserable. He had seen two Urologists and had tried antibiotics and anti-inflammatories with no effect. Pain was worse with stress and worry and when his children were being noisy!
Luca is a 23-year-old who works in marketing for his family business. He had a 6-month history of groin pain that had progressed to testicular and penile pain. He had multiple investigations, all of which were normal.  He had taken 3 courses of antibiotics as well as trying massage and naturopathy, all with no improvement. Pain was worse with sitting, standing and erection and Luca said his penis looked and felt different and was sensitive to touch. 

Making sense of the contributing factors

Taking a biopsychosocial (Biology/Psychological/Social) whole person approach, we could see that there were many contributing factors to both Geoff and Luca’s pelvic pain - 
Biological; Poor awareness of pelvic movement.  His pelvic floor muscles were tense, tender and he had difficulty relaxing them. 
Psychological; He reported moderate stress and depression, mild anxiety, significant fear of movement and negative pain thoughts. 
Social; History of adverse childhood experiences with physical and emotional abuse. Busy life with work demands and 4 children with no family support.  
Biological; tension and guarding through his abdominal muscles, significantly increased tension of his pelvic floor muscles 
Psychological; mild stress and anxiety, extremely worried about his pain, feeling helpless, couldn’t stop thinking about the pain and was worried about exercise making it worse. 
Social; supportive girlfriend but not being able to have sex was impacting their relationship which was worrying to him

Collaborative management plan

Geoff ; Geoff really wanted to understand why he had his pain and embraced learning about the science of pain.  He realised that his fear was driving his muscle tension and he could help his body and mind to relax through breathing, positive thoughts, mindful movement and relaxation exercises.  He was presented with options and chose what he was most interested in and felt he could incorporate into his busy life. 
Luca; Luca learnt more about the science of pain and then started to connect his body and mind through body scanning and specific movement practices. He learnt how to relax his pelvic floor with the help of ultrasound for feedback.  Luca performed pelvic exercises and stretches that reduced tension in his abdominal muscles, hip and groin.  He progressed to touch different parts of his pelvis whilst being aware of his thoughts, emotions and his body response and developed skills to break the cycle of worry about intimacy. 

How are they now?

Geoff; Geoff attended physio intermittently over an 18 month period, understanding that it can take time to change pain when it has been around for 10 years.  He now has no scrotal, perineal or anal pain and is able to quickly notice what triggers his pelvic tension and has strategies to reduce it.   His bladder is working well and pleasingly his sexual function has significantly improved. He scored his goal achievement as 9/10,  is enjoying life and spending time with his children.  
Luca; Luca attended for 6 consultations.  He is pain free, is no longer fearful of intimacy and has reduced his constant worry. His confidence is much improved, his feelings about his penis also are more positive and he is enjoying sex with his girlfriend. 

Final thoughts

Geoff and Luca are typical examples of men we support every day who are suffering in silence with their pelvic and sexual pain. Through a whole person and patient centered approach, they both collaborated with their Pelvic Health Physios, and were open to addressing not just the physical contributors but also the emotional and psychological factors as well. They both wished they had found WMHP earlier!
**Names have been changed to respect the privacy of these patients.
May 2022