Skip to main content
SpringerLink
Log in

The Pelvic Floor and Male Sexual Function

  • Chapter
The Overactive Pelvic Floor

Abstract

Sexual function is essential to good health and well-being in men. The male pelvic floor, including muscles and connective tissue structures therein, plays a key role in male sexual function. In this chapter, the anatomy and physiology of the male pelvic floor are described. Recent literature is then presented regarding pelvic floor function and dysfunction as it pertains to common male sexual dysfunctions, such as erectile dysfunction (ED), premature ejaculation (PE), orgasmic dysfunction, and pelvic pain such as genital pain and ejaculatory pain. This information should inform plans of care when health care providers treat men with sexual dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Porst H, Montorsi F, Rosen RC, Gaynor L, Grupe S, Alexander J. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol. 2007;51(3):816–23; discussion 24.

    Article  PubMed  Google Scholar 

  2. Althof SE. Prevalence, characteristics and implications of premature ejaculation/rapid ejaculation. J Urol. 2006;175(3 Pt 1):842–8.

    Article  PubMed  Google Scholar 

  3. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54–61.

    CAS  PubMed  Google Scholar 

  4. Billups KL. Erectile dysfunction as an early sign of cardiovascular disease. Int J Impot Res. 2005;17 Suppl 1:S19–24.

    Article  PubMed  Google Scholar 

  5. Tran CN, Shoskes DA. Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome. World J Urol. 2013;31(4):741–6.

    Article  PubMed  Google Scholar 

  6. Shoskes DA. The challenge of erectile dysfunction in the man with chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2012;13(4):263–7.

    Article  PubMed  Google Scholar 

  7. Kawanishi Y, Kishimoto T, Kimura K, Yamaguchi K, Nakatuji H, Kojima K, et al. Spring balance evaluation of the ischiocavernosus muscle. Int J Impot Res. 2001;13(5):294–7.

    Article  CAS  PubMed  Google Scholar 

  8. Colpi GM, Negri L, Nappi RE, Chinea B. Perineal floor efficiency in sexually potent and impotent men. Int J Impot Res. 1999;11(3):153–7.

    Article  CAS  PubMed  Google Scholar 

  9. Dorey G. Conservative treatment of erectile dysfunction. 3: literature review. Br J Nurs. 2000;9(13):859–63.

    Article  CAS  PubMed  Google Scholar 

  10. Aubin S, Berger R, Heiman JR, Ciol MA. The association between sexual function, pain, and psychological adaptation of men diagnosed with chronic pelvic pain syndrome type III. J Sex Med. 2008;5:657–67.

    Article  PubMed  Google Scholar 

  11. Smith KB, Pukall CF, Tripp DA, Nickel JC. Sexual and relationship functioning in men with chronic prostatitis/chronic pelvic pain syndrome and their partners. Arch Sex Behav. 2007;36(2):301–11.

    Article  PubMed  Google Scholar 

  12. Mehik A, Hellström P, Sarpola A, Lukkarinen O, Järvelin MR. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int. 2001;88(1):35–8.

    Article  CAS  PubMed  Google Scholar 

  13. Lee SWH, Liong ML, Yuen KH, Leong WS, Cheah PY, Khan NAK, et al. Adverse impact of sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome. Urology. 2007;71(1):79–84.

    Article  Google Scholar 

  14. Tan JK, Png DJ, Liew LC, Li MK, Wong ML. Prevalence of prostatitis-like symptoms in Singapore: a population-based study. Singapore Med J. 2002;43(4):189–93.

    CAS  PubMed  Google Scholar 

  15. Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374–80.

    Article  PubMed  Google Scholar 

  16. Stoker J. Anorectal and pelvic floor anatomy. Best Pract Res Clin Gastroenterol. 2009;23(4):463–75.

    Article  PubMed  Google Scholar 

  17. Delancey J. Anatomy of genital support. In: Benson J, editor. Female pelvic floor disorders. New York: Norton Medical Books; 1992.

    Google Scholar 

  18. Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006;18(7):507–19.

    Article  CAS  PubMed  Google Scholar 

  19. Raizada V, Mittal RK. Pelvic floor anatomy and applied physiology. Gastroenterol Clin North Am. 2008;37(3):493–509.

    Article  PubMed Central  PubMed  Google Scholar 

  20. 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(1):4–13.

    Article  PubMed  Google Scholar 

  21. Pischedda A, Fusco F, Curreli A, Grimaldi G, Pirozzi FF. Pelvic floor and sexual male dysfunction. Arch Ital Urol Androl. 2013;85(1):1–7.

    Article  PubMed  Google Scholar 

  22. Drake RL, Vogl AW, Mitchell AWM. Gray’s Anatomy for students. 2nd ed. Philadelphia: Elsevier; 2009.

    Google Scholar 

  23. Delancey J. Functional anatomy of the female pelvis. In: Kursh E, McGuire EJ, editors. Female Urology. 1st ed. Philadelphia: Lippincott; 1994.

    Google Scholar 

  24. Percy JP, Neill ME, Swash M, Parks AG. Electrophysiological study of motor nerve supply of pelvic floor. Lancet. 1981;1(8210):16–7.

    Article  CAS  PubMed  Google Scholar 

  25. Dorschner W, Biesold M, Schmidt F, Stolzenburg JU. The dispute about the external sphincter and the urogenital diaphragm. J Urol. 1999;162(6):1942–5.

    Article  CAS  PubMed  Google Scholar 

  26. Nadelhaft I, Booth AM. The location and morphology of preganglionic neurons and the distribution of visceral afferents from the rat pelvic nerve: a horseradish peroxidase study. J Comp Neurol. 1984;226(2):238–45.

    Article  CAS  PubMed  Google Scholar 

  27. Giuliano F. Neurophysiology of erection and ejaculation. J Sex Med. 2011;8 Suppl 4:310–5.

    Article  PubMed  Google Scholar 

  28. Dobberfuhl AD, Oti T, Sakamoto H, Marson L. Identification of CNS neurons innervating the levator ani and ventral bulbospongiosus muscles in male rats. J Sex Med. 2014;11(3):664–77.

    Article  CAS  PubMed  Google Scholar 

  29. Holmes GM, Sachs BD. Physiology and mechanics of rat levator ani muscle: evidence for a sexual function. Physiol Behav. 1994;55(2):255–66.

    Article  CAS  PubMed  Google Scholar 

  30. NIH consensus conference. Impotence. NIH consensus development panel on Impotence. JAMA. 1993;270(1):83–90.

    Google Scholar 

  31. Nicolosi A, Moreira ED, Shirai M, Bin Mohd Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology. 2003;61(1):201–6.

    Article  PubMed  Google Scholar 

  32. Poirier P, Charpy A. Traite d’anatomie Humaine. Paris: Masson; 1901.

    Google Scholar 

  33. Dorey G. Pelvic dysfunction in men. Chichester: Wiley; 2006.

    Google Scholar 

  34. Claes H, Baert L. Pelvic floor exercise versus surgery in the treatment of impotence. Br J Urol. 1993;71(1):52–7.

    Article  CAS  PubMed  Google Scholar 

  35. Lavoisier P, Courtois F, Barres D, Blanchard M. Correlation between intracavernous pressure and contraction of the ischiocavernosus muscle in man. J Urol. 1986;136(4):936–9.

    CAS  PubMed  Google Scholar 

  36. Lavoisier P, Roy P, Dantony E, Watrelot A, Ruggeri J, Dumoulin S. Pelvic-floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Phys Ther. 2014;94(12):1731–43.

    Article  PubMed  Google Scholar 

  37. Siegel AL. Pelvic floor muscle training in males: practical applications. Urology. 2014;84(1):1–7.

    Article  PubMed  Google Scholar 

  38. Wespes E, Nogueira MC, Herbaut AG, Caufriez M, Schulman CC. Role of the bulbocavernosus muscles on the mechanism of human erection. Eur Urol. 1990;18(1):45–8.

    CAS  PubMed  Google Scholar 

  39. Claes H, van Hove J, van de Voorde W, Lauweryns J, de Roo E, Lysens R, et al. Pelvi-perineal rehabilitation for dysfunctioning erections. A clinical and anatomo-physiologic study. Int J Impot Res. 1993;5(1):13–26.

    CAS  PubMed  Google Scholar 

  40. Colpi G, Castiglioni M, Scroppo F, Mariani M. Perineal floor rehabilitation by biofeedback. A new treatment for erectile dysfunction? Turkish J Urol. 1991;17(Suppl):S12–3.

    Google Scholar 

  41. Schouman M, Lacroix P. Role of pelvi-perineal rehabilitation in the treatment of cavernous venous leakage. Ann Urol (Paris). 1991;25(2):93–4.

    CAS  Google Scholar 

  42. Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract. 2004;54(508):819–25.

    PubMed Central  PubMed  Google Scholar 

  43. Dorey G, Speakman MJ, Feneley RC, Swinkels A, Dunn CD. Pelvic floor exercises for erectile dysfunction. BJU Int. 2005;96(4):595–7.

    Article  PubMed  Google Scholar 

  44. Colpi G, Negri L, Scroppo F, Grugnetti C. Perineal floor rehabilitation: a new treatment for venogenic impotence. J Endocrinol Invest. 1994;17:34.

    Google Scholar 

  45. Van Kampen M, De Weerdt W, Claes H, Feys H, De Maeyer M, Van Poppel H. Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation. Phys Ther. 2003;83(6):536–43.

    PubMed  Google Scholar 

  46. Shafik A. The role of the levator ani muscle in evacuation, sexual performance and pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(6):361–76.

    Article  CAS  PubMed  Google Scholar 

  47. McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID, et al. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. J Sex Med. 2008;5(7):1590–606.

    Article  PubMed  Google Scholar 

  48. Symonds T, Roblin D, Hart K, Althof S. How does premature ejaculation impact a man s life? J Sex Marital Ther. 2003;29(5):361–70.

    Article  CAS  PubMed  Google Scholar 

  49. Pastore AL, Palleschi G, Leto A, Pacini L, Iori F, Leonardo C, et al. A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation. Int J Androl. 2012;35(4):528–33.

    Article  CAS  PubMed  Google Scholar 

  50. Masters WH, Johnson VE. Human sexual inadequacy. London: Churchill; 1970. xi, 467 pp.

    Google Scholar 

  51. Pastore AL, Palleschi G, Fuschi A, Maggioni C, Rago R, Zucchi A, Costantini E, Carbone A. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. Ther Adv Urol. 2014;6(3):83–8.

    Article  PubMed Central  PubMed  Google Scholar 

  52. La Pera G, Nicastro A. A new treatment for premature ejaculation: the rehabilitation of the pelvic floor. J Sex Marital Ther. 1996;22(1):22–6.

    Article  PubMed  Google Scholar 

  53. Piediferro G, Colpi EM, Castiglioni F, Scroppo FI. Premature ejaculation. 3. Therapy. Arch Ital Urol Androl. 2004;76(4):192–8.

    PubMed  Google Scholar 

  54. Shoskes DA, Prots D, Karns J, Horhn J, Shoskes AC. Greater endothelial dysfunction and arterial stiffness in men with chronic prostatitis/chronic pelvic pain syndrome—a possible link to cardiovascular disease. J Urol. 2011;186(3):907–10.

    Article  PubMed  Google Scholar 

  55. Schaeffer AJ, Datta NS, Fowler JE, Krieger JN, Litwin MS, Nadler RB, et al. Overview summary statement. Diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Urology. 2002;60(6 Suppl):1–4.

    Article  PubMed  Google Scholar 

  56. Krieger JN, Riley DE, Cheah PY, Liong ML, Yuen KH. Epidemiology of prostatitis: new evidence for a world-wide problem. World J Urol. 2003;21(2):70–4.

    Article  PubMed  Google Scholar 

  57. Roberts RO, Jacobson DJ, Girman CJ, Rhodes T, Lieber MM, Jacobsen SJ. Prevalence of prostatitis-like symptoms in a community based cohort of older men. J Urol. 2002;168(6):2467–71.

    Article  PubMed  Google Scholar 

  58. McNaughton Collins M, Pontari MA, O’Leary MP, Calhoun EA, Santanna J, Landis JR, et al. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med. 2001;16(10):656–62.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Wenninger K, Heiman JR, Rothman I, Berghuis JP, Berger RE. Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol. 1996;155(3):965–8.

    Article  CAS  PubMed  Google Scholar 

  60. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010;75(6):1249–53.

    Article  PubMed  Google Scholar 

  61. Liang C-Z, Zhang X-J, Hao Z-Y, Shi H-Q, Wang K-X. Prevalence of sexual dysfunction in Chinese men with chronic prostatitis. BJU Int. 2004;93:568–70.

    Article  PubMed  Google Scholar 

  62. Gonen M, Kalkan M, Cenker A, Ozkardes H. Prevalence of premature ejaculation in Turkish men with chronic pelvic pain syndrome. J Androl. 2005;26(5):601–3.

    Article  PubMed  Google Scholar 

  63. Screponi E, Carosa E, Di Stasi SM, Pepe M, Carruba G, Jannini EA. Prevalence of chronic prostatitis in men with premature ejaculation. Urology. 2001;58(2):198–202.

    Article  CAS  PubMed  Google Scholar 

  64. Kaplan HS. The new sex therapy; active treatment of sexual dysfunctions. New York: Brunner/Mazel; 1974. xvi, 544 pp.

    Google Scholar 

  65. Shoskes DA, Landis JR, Wang Y, Nickel JC, Zeitlin SI, Nadler R, et al. Impact of post-ejaculatory pain in men with category III chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2004;172(2):542–7.

    Article  PubMed  Google Scholar 

  66. Schaeffer AJ, Landis JR, Knauss JS, Propert KJ, Alexander RB, Litwin MS, et al. Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J Urol. 2002;168(2):593–8.

    Article  PubMed  Google Scholar 

  67. Anderson RU, Wise D, Sawyer T, Chan CA. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urol. 2006;176(4 Pt 1):1534–8; discussion 8–9.

    Article  PubMed  Google Scholar 

  68. Hetrick DC, Ciol MA, Rothman I, Turner JA, Frest M, Berger RE. Musculoskeletal dysfunction in men with chronic pelvic pain syndrome type III: a case-control study. J Urol. 2003;170(3):828–31.

    Article  PubMed  Google Scholar 

  69. Berger RE, Ciol MA, Rothman I, Turner JA. Pelvic tenderness is not limited to the prostate in chronic prostatitis/chronic pelvic pain syndrome (CPPS) type IIIA and IIIB: comparison of men with and without CP/CPPS. BMC Urol. 2007;7:17.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Shoskes DA, Berger R, Elmi A, Landis JR, Propert KJ, Zeitlin S, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008;179(2):556–60.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Doggweiler-Wiygul R. Urologic myofascial pain syndromes. Curr Pain Headache Rep. 2004;8(6):445–51.

    Article  PubMed  Google Scholar 

  72. Simons DG, Travell JG, Simons LS. Travell and Simons myofascial pain and dysfunction: the trigger point manual, upper half of body, vol. 1. 2nd ed. Baltimore: Williams & Wilkins; 1999.

    Google Scholar 

  73. Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. 2006;355(16):1690–8.

    Article  CAS  PubMed  Google Scholar 

  74. Lee JC, Muller CH, Rothman I, Agnew KJ, Eschenbach D, Ciol MA, et al. Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls. J Urol. 2003;169(2):584–7; discussion 7–8.

    Article  PubMed  Google Scholar 

  75. Schaeffer AJ, Knauss JS, Landis JR, Propert KJ, Alexander RB, Litwin MS, et al. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study. J Urol. 2002;168(3):1048–53.

    Article  PubMed  Google Scholar 

  76. Segura JW, Opitz JL, Greene LF. Prostatosis, prostatitis or pelvic floor tension myalgia? J Urol. 1979;122(2):168–9.

    CAS  PubMed  Google Scholar 

  77. Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA. Neurourological insights into the etiology of genitourinary pain in men. J Urol. 1999;161(3):903–8.

    Article  CAS  PubMed  Google Scholar 

  78. Davis SN, Morin M, Binik YM, Khalife S, Carrier S. Use of pelvic floor ultrasound to assess pelvic floor muscle function in Urological Chronic Pelvic Pain Syndrome in men. J Sex Med. 2011;8(11):3173–80.

    Article  PubMed  Google Scholar 

  79. Khorasani B, Arab AM, Sedighi Gilani MA, Samadi V, Assadi H. Transabdominal ultrasound measurement of pelvic floor muscle mobility in men with and without chronic prostatitis/chronic pelvic pain syndrome. Urology. 2012;80(3):673–7.

    Article  PubMed  Google Scholar 

  80. Cornel EB, van Haarst EP, Schaarsberg RW, Geels J. The effect of biofeedback physical therapy in men with Chronic Pelvic Pain Syndrome Type III. Eur Urol. 2005;47(5):607–11.

    Article  PubMed  Google Scholar 

  81. Litwin MS, McNaughton-Collins M, Fowler FJ, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999;162(2):369–75.

    Article  CAS  PubMed  Google Scholar 

  82. Clemens JQ, Nadler RB, Schaeffer AJ, Belani J, Albaugh J, Bushman W. Biofeedback, pelvic floor re-education, and bladder training for male chronic pelvic pain syndrome. Urology. 2000;56(6):951–5.

    Article  CAS  PubMed  Google Scholar 

  83. Nadler RB. Bladder training biofeedback and pelvic floor myalgia. Urology. 2002;60(6 Suppl):42–3; discussion 4.

    Article  PubMed  Google Scholar 

  84. Duclos AJ, Lee CT, Shoskes DA. Current treatment options in the management of chronic prostatitis. Ther Clin Risk Manag. 2007;3(4):507–12.

    PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Fundamental Physical Therapy & Pelvic Wellness, Inc., 5555 Reservoir Dr., Suite 300, San Diego, CA, 92120, USA

    Deborah S. Cohen PT,MS,CSCS,COMT,WCS

  2. Andrology and Sexual Medicine, San Diego, CA, USA

    Joshua Gonzalez M.D.

  3. Department of Sexual Medicine, Alvarado Hospital, San Diego, CA, USA

    Irwin Goldstein M.D.

Authors
  1. Deborah S. Cohen PT,MS,CSCS,COMT,WCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua Gonzalez M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Irwin Goldstein M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah S. Cohen PT,MS,CSCS,COMT,WCS .

Editor information

Editors and Affiliations

  1. Urogynecology and Pelvic Floor Service, Assaf Harofeh Medical Center, Zerifin, Israel

    Anna Padoa

  2. Inner Stability, Ltd, Beit Shemesh, Israel

    Talli Y. Rosenbaum

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Cohen, D.S., Gonzalez, J., Goldstein, I. (2016). The Pelvic Floor and Male Sexual Function. In: Padoa, A., Rosenbaum, T. (eds) The Overactive Pelvic Floor. Springer, Cham. https://doi.org/10.1007/978-3-319-22150-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22150-2_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22149-6

  • Online ISBN: 978-3-319-22150-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation