Men's Sexual Health
Today for Men's Health Month we're talking about sex. Sex is something we hear talked about a lot in popular culture when it's something sexy or fun. But what about when it's not?
We have conversations with men every day about how incontinence, pain, prostate surgery or erectile dysfunction have impacted on their sex life. While these conversations can feel embarrassing at the start, there is actually a lot that can be done to help improve sexual function in each of these situations.
Bladder leakage is something that has an enormous impact on a man's mental wellbeing. It often is accompanied by anxiety, depression, embarrassment and a sense of loss, loss of control over your body, loss of masculinity or loss of sexuality. Men tell us that they are worried they might smell despite having washed themselves, or that wearing a continence pad means their partner won't find them as attractive, or the biggest worry: what if they leak during sex?
There is good news though. First of all, you're not alone. There are thousands of Aussie men going through similar issues as we speak. Depending on what the cause of the incontinence is, there are different ways to manage it or treat it. For some types of incontinence, pelvic floor exercises and simple lifestyle changes can reduce or even eliminate the leaking. For others we can use a range of physio and medical options to treat. If your incontinence can't be completely eliminated there are still lots of strategies to help to work around it in the bedroom. A great resource on the topic of incontinence and sexuality has been created by the Continence Foundation of Australia here.
Pelvic pain is a complex issue, but it can have a big impact on sexuality. For some, having pain can make it very difficult to get aroused. Others may experience painful erections or post-ejaculation pain, which is a very distressing issue. There are lots of different conditions that cause pain in the pelvis such as: Chronic Prostatitis, Pudendal Neuralgia, or Peyronie's Disease. Pain can also be from the spine, hips, pelvic floor muscles or organs (such as in bladder or rectal pain). The first step to addressing your pain is to see your GP to screen for more serious medical issues, and if these are ruled out then it's time to see a Pelvic Health Physiotherapist. There are lots of ways we can help to manage your pain, from pelvic floor relaxation, to stretches, to TENS or therapeutic ultrasound - the list keeps going!
Following prostatectomy, all men experience some degree or erectile function loss. This can last between 6 months to 2 years if the surgery was nerve-sparing. Many Urologists are now recommending early rehab not just for bladder control after surgery, but also for erectile function. Penile rehabilitation is the term we use for all the things you can do to both keep the penis healthy in the early stages post surgery, and then start to rehabilitate erectile and sexual function. Part of penile rehabilitation involves a medical approach, such as taking certain medications or having penile injections. The other part involves lifestyle, exercise, pelvic floor exercises, and then specific strategies for erectile function including using a pump device. Alongside your physiotherapy rehab, we recommend all men following prostatectomy have a look at these two websites here and here for more information about rehabilitating erectile and sexual function. Other great resources include PROST! which is exercise post prostate cancer, and The Penis Project Podcast which has a good mix of medical information and patient stories to learn more about Men's health issues.
Erectile issues don't just occur after prostate surgery, they can happen for a whole range of reasons. A really common reason is having an underlying Cardiovascular issue. Erections are dependent on good blood flow, so if you have an issue such as high blood pressure, heart disease, or something that affects circulation such as type 2 diabetes or atherosclerosis (plaques forming in your arteries), then erectile function can be impacted by this.
performance anxiety, or the stress that comes from embarrassment. Addressing the stress and the cause of that stress is important in addressing sexual function issues.
And finally, we wouldn't be Pelvic Health physios if we didn't also mention how the pelvic floor muscles can impact erectile function. Weaker pelvic floor muscles might lead to difficulty maintaining an erection, muscles that are too tight might not relax enough to allow
blood flow for establishing and erection or they may contribute to pain with ejaculation. These are all issues that physio can help with!
There are other issues that can impact erectile function such as neurological diseases, nerve injury, injury to the penis itself and other systemic diseases too. It's always important to speak with your GP about erectile changes so you can thoroughly investigate why the changes are happening.
So no matter your issue, there is help available. If you're not sure if Pelvic Health Physio can help you, get in touch with us and one of our Physios can have a chat with you.