Happy Men’s Health Month!

This month is all about raising awareness of a critical issue: men are significantly less likely to seek treatment from healthcare providers. Many push through their symptoms and try to manage on their own.^1,2,3 One space where this gender disparity is especially evident is pelvic health.

The first problem? Many people don’t even realize that men have pelvic floors. If you learn one thing from me: everyone has a pelvic floor. Everyone.

A recent study published in the Journal of Women’s and Pelvic Health Physical Therapy found that 38% of men surveyed reported a urinary complaint. Additionally, 28 – 41% of men, depending on age group, reported issues with sexual function. Among those with bowel issues, 65% also had urinary complaints.⁴ These numbers are remarkably similar to what we see in women – 25-32% of women experience some form of pelvic floor dysfunction (including bowel, bladder, and sexual concerns).^{5, 6}

When men do make it to their primary care or urologist, they are often referred to pelvic floor physical therapy. In my experience, urologists are diligent about referring to pelvic floor therapy. The irony? There are so few pelvic health PTs or OTs who treat male patients that many men are left with nowhere to go.

The men I see in my office often tell me how difficult it was to find someone who would treat them. “Every place I called said they don’t treat men.”

There are a number of contributing factors. Generally, pelvic health providers are women and may feel more comfortable treating the same sex. Safety concerns may also play a role. And for some, it’s simply that they choose not to take coursework involving rectal techniques.

That doesn’t even cover the patient side of things. Most male patients have no warning as to what pelvic floor PT usually involves (read an overview here). Some don’t make the call to schedule, looking instead for ways they can fix the issue at home. Even if they get into the clinic, they often are skeptical of how much they will get out of it. In general, people think that medication or surgery is often the only answer for improving their symptoms.

This isn’t the case! Muscles need to be challenged through resistance and coordination training to get better. The pelvic floor is no exception, it just has higher stakes because it helps to control your bowel and bladder. I have had male patients see significant improvement in their constipation, urinary incontinence, and sexual dysfunction using a variety of different treatments. Treatment always includes some kind of strength training and can include teaching to contract the pelvic floor with internal cues (rectal exam).

Speaking from personal experience, I never expected to treat men when I started in pelvic floor PT. I pursued this path because I saw a lack of resources for my female friends, especially postpartum moms. My passion for treating pelvic pain grew from coursework and my own experiences. Along the way, I began seeing male patients because I saw that they had the same lack of access as my female patients. It has become obvious to me since starting in pelvic health that the lack of resources is for ALL pelvic floor concerns, regardless of gender.

In an ideal world, we would have true health equity. Women wouldn’t have to wait four more years than men to be diagnosed with something as straightforward as diabetes.⁷ And men would feel comfortable seeking preventative care—and get the treatment they need for pelvic health issues without stigma or delay.

We’ve made progress breaking the stigma around the pelvic floor for women. It’s time to break it for men too.

-Naomi

1. Daher M, Al Rifai M, Kherallah RY, Rodriguez F, Mahtta D, Michos ED, Khan SU, Petersen LA, Virani SS. Gender disparities in difficulty accessing healthcare and cost-related medication non-adherence: The CDC behavioral risk factor surveillance system (BRFSS) survey. Prev Med. 2021 Dec;153:106779. doi: 10.1016/j.ypmed.2021.106779. Epub 2021 Sep 3. PMID: 34487748; PMCID: PMC9291436.

2. Banks I. No man’s land: men, illness, and the NHS. BMJ. 2001 Nov 3;323(7320):1058-60. doi: 10.1136/bmj.323.7320.1058. PMID: 11691768; PMCID: PMC1121551.

3. Höhn A, Gampe J, Lindahl-Jacobsen R, Christensen K, Oksuyzan A. Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark. J Epidemiol Community Health. 2020 Jun;74(7):573-579. doi: 10.1136/jech-2019-213435. Epub 2020 Apr 17. PMID: 32303595; PMCID: PMC7337231.

4. Woodard, Chad PT, PhD1; Krakowsky, Mackenna PT, DPT2; Widawsky, Jolie PT, DPT2; Wolkenfeld, Tzvi PT, DPT2. Prevalence of Pelvic Health Conditions and Associated Factors in a Male Population. Journal of Women’s & Pelvic Health Physical Therapy 49(1):p 19-25, January/March 2025. | DOI: 10.1097/JWH.0000000000000321

5. Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, Markland AD. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014 Jan;123(1):141-148. doi: 10.1097/AOG.0000000000000057. PMID: 24463674; PMCID: PMC3970401.

6. Kenne, K.A., Wendt, L. & Brooks Jackson, J. Prevalence of pelvic floor disorders in adult women being seen in a primary care setting and associated risk factors. Sci Rep 12, 9878 (2022). https://doi.org/10.1038/s41598-022-13501-w

7. Sun TY, Hardin J, Nieva HR, Natarajan K, Cheng RF, Ryan P, Elhadad N. Large-scale characterization of gender differences in diagnosis prevalence and time to diagnosis. medRxiv [Preprint]. 2023 Oct 16:2023.10.12.23296976. doi: 10.1101/2023.10.12.23296976. PMID: 37873224; PMCID: PMC10592987.