Men's Health Spotlight: Non-Painful Sexual Dysfunction

June 30, 2020

June is Men’s Health Month. In the past, our blog has featured articles on men’s sexual health that have mostly focused on pain with sexual interactions. However, what if you don’t have pain with sexual interactions, but you are left troubled or dissatisfied following sex and/or intimacy? Would this issue be categorized as a sexual dysfunction?


In PT, sex* is what we refer to as an “activity of daily living” or ADL. If you are not able to engage in this ADL without it negatively affecting your quality of life, there is a dysfunction. Moreover, issues can manifest in any part of the sexual response cycle. And believe it or not, the timing of pain and/or dysfunction gives the physical therapist a clue as to what structures and systems are involved.

*The term ‘sex’ as it is used here refers to any type of sexual interaction with a partner as defined by an individual.

The male sexual response is divided into 4 phases: 1) excitation, 2) plateau, 3) orgasm, 4) resolution. Penile erection occurs during the first phase of the sexual response cycle - excitation. This mechanism is controlled by the ‘fight or flight’ part of the nervous system. Ejaculation occurs during the third stage - orgasm. It is controlled by the ‘rest and relax’ part of the nervous system. (*I want to note that not every person reaches the orgasm stage of the cycle - but again, if this is causing someone distress, it is dysfunctional.) Both parts of the nervous system are always ‘on’ in a person, but, as we see in the sexual response cycle, one can be more in control than the other. Ultimately, the nervous system is in a balancing act during this cycle and must be able to switch between its two parts. However, if the brain and body get stuck in one mode, the body responds to reflect this change. Unfortunately, this change can impact the sexual response and be a source of distress and confusion for many.

The pelvic floor and the nervous system are intimately connected which makes many question whether pelvic health issues were a nervous system or muscular issue first. Meaning, did a change in the nervous system response cause a change in pelvic floor muscle firing or vice versa? Honestly, it does not necessarily matter which came first because all are addressed at pelvic health physical therapy. Pelvic health physical therapists are trained to examine lifestyle and behavioral factors as well as musculoskeletal functioning as they relate to bowel, bladder, and sexual health. Just as a muscle can be trained to get stronger and more coordinated, the nervous system can as well.

Sexual dysfunctions are, on the whole, multifactorial. There are psychological and biological causes that must be considered. Medications, surgeries, and trauma can all contribute to the manifestation of a sexual dysfunction. For that reason, it is important to be an advocate for your health and bring up these issues to your healthcare provider. Pelvic health physical therapy is an excellent resource to talk about sexual health and ways to improve function for optimized well-being.

Premature ejaculation is defined as ejaculation that occurs less than 1 minute following penetration. The causes of premature ejaculation are multifactorial, having both psychological and biological causes. However, through behavior training and pelvic floor muscle retraining, ejaculation timing can be retrained. If ejaculation is happening spontaneously.

Erectile dysfunction can have multiple causes. Underlying health issues such as cardiac and vascular issues, surgeries, and psychological dysfunctions can all contribute to the manifestation of erectile dysfunction. However, the pelvic floor and central nervous system play an integral role in the male sexual response and can affect the ability to maintain an erection.

But, how do you retrain the nervous system if that is the underlying culprit? Pelvic PTs are trained in techniques that help bring more balance to the nervous system via behavioral interventions that patients will come to utilize in their everyday life for overall well-being. These components can be addressed by a pelvic floor physical therapist.

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

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Dr. Ashley Newton

Center Director | Physical Therapist
Ashley Newton is a Doctor of Physical Therapy and Evidence In Motion Pelvic Health Certified (PHC) practitioner with a special interest in adult pelvic floor issues and yoga-related injuries. She works at Activcore in Princeton, NJ, located just 2 miles from Princeton University.
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