Understanding Male Pelvic Pain: An Integrative Approach to Treatment

Pelvic pain is a condition that affects 1 in 12 Australian men, yet it remains widely misunderstood and often misdiagnosed. Pain can occur anywhere between the belly button and the SIT bones (the bony structures at the base of the pelvis) and, if it persists for more than six months, it is classified as chronic or persistent pelvic pain.

Unlike many other pain conditions, male pelvic pain doesn’t always show up on routine scans or medical tests. This often leads to frustration, misdiagnosis, and ineffective treatments. This significantly affects a man’s quality of life. However, with the right approach, pelvic pain can be managed and improved. At Eastern Osteopathy, The Pelvic Place Melbourne we pride ourselves in addressing your pelvic pain using our osteopathic foundations and pelvic health training to holistically address your concerns

What Does Male Pelvic Pain Feel Like?

Pelvic pain can manifest in many ways, and every man’s experience is different. Some of the most common symptoms include:

• Pain when sitting – discomfort in the tailbone (coccyx), perineum, rectum, or genitals.

• Pressure, throbbing, tingling, or burning sensations – felt anywhere in the pelvis, including the penis, testicles, urethra, tailbone, or rectum.

• Bowel issues – such as rectal or anal pain, difficulty emptying the bowels, pain during bowel movements, or trouble passing wind.

• Bladder problems – including bladder pain, frequent urination, reduced urine flow, or a feeling of incomplete emptying.

• Sexual pain – discomfort during or after intercourse or with ejaculation.

• Mental health challenges – anxiety, depression, and high stress levels are common in men experiencing pelvic pain.
  

Why Is Male Pelvic Pain So Hard to Treat?

One of the biggest challenges with pelvic pain is that it often doesn’t have a clear, identifiable cause. Many men undergo multiple medical tests—such as scans, ultrasounds, or blood work—only to be told that everything looks “normal.” This can be incredibly frustrating and disheartening.

However, just because pelvic pain doesn’t appear on a scan doesn’t mean it isn’t real. In many cases, the pain is related to muscle tension, nerve irritation, postural imbalances, or stress-related factors, rather than an obvious structural issue. That’s why an integrative approach—which looks at the whole person, rather than just one part of the body—is often the key to effective treatment.

An Integrative Approach: How Osteopathy Can Help

At Eastern Osteopathy, we assist with male pelvic pain through a holistic and evidence-based approach that combines osteopathy and pelvic health. Rather than focusing only on the site of pain, we assess the entire body, looking for underlying issues that may be contributing to your symptoms.

What Does Treatment Involve?

Each treatment plan is tailored to the individual, but it may include:

✔️ Hands-on manual therapy – to release muscle tension, improve blood flow, and reduce nerve irritation.
✔️ Postural and movement retraining – to correct imbalances that may be putting strain on the pelvic region.
✔️ ️ Breathwork and relaxation techniques – to address stress-related tension in the pelvic floor.
✔️ Bladder and bowel retraining – to improve symptoms related to urination and digestion.
✔️ Lifestyle and ergonomic advice – to help manage pain triggers, whether it's sitting posture, physical activity, or stress levels.
✔️ Collaboration with other healthcare professionals – including GPs, psychologists, or pain specialists when needed.

The Mind-Body Connection in Pelvic Pain

Many men are surprised to learn that stress, anxiety, and past trauma can play a significant role in pelvic pain. The pelvic floor muscles respond to emotional stress just like any other muscle in the body—by tightening up. If this tension becomes chronic, it can lead to persistent pain, urinary problems, and sexual dysfunction.

That’s why our treatment approach focuses not just on the physical symptoms but also on nervous system regulation, relaxation techniques, and stress management to help break the pain cycle.

Regain Your Quality of Life

Living with pelvic pain can be isolating and frustrating, but you don’t have to go through it alone. With the right treatment and support, it’s possible to reduce pain, improve function, and reclaim your quality of life.

If you’re experiencing pelvic pain, we’re here to help. Kathryn, Meg and Rose will take the time to understand your symptoms, assess your condition thoroughly, and create a personalized treatment plan that supports your recovery.

Don’t let pelvic pain control your life—take the first step toward relief today. Book an appointment with one of our Osteopaths today and start your journey to feeling better.

What is Pudendal Neuralgia?

Before I start, let me introduce you to the pudendal nerve. The pudendal nerve originates at the sacrum levels S2-4, it then travels through the Alcocks canal and up along the pubic bone. It has three branches which supply the rectum, clitoris and the perineum. The nerve is made up of sensory, motor and autonomic fibers. When this nerve is irritated, which can occur anywhere along its entire length, Pudendal Neuralgia (PN) is the result.

What are the symptoms of Pudendal Neuralgia?

The Pudendal nerve is a complex nerve with numerous functions and branches, when it is compromised the symptoms can vary greatly depending on the branch or fibers affected.

• Increased pain when sitting

• Sharp and/or altered sensation in the area between the genitals and anus. 

• Can be described as a prickling, itching swollen sensation in the vulva, rectum or perineum. 

• Clitoral pain/sensitivity

• The feeling of recurrent bladder infections

How did I get Pudendal Neuralgia?

The nerve compression/irritation can occur due to of a number of reasons, including;

• Vaginal birth and stretching of the nerve.

• Excessive sitting where the inner parts of the sit bones are compressed, like when riding a bike. 

• Mechanical force/trauma to the area.

• Hypertonic pelvic floor muscles that compress the nerve. 

What is the treatment for Pudendal Neuralgia?

We recommend seeing Kathryn Johns, our osteopath who has extensive training in pelvic health and chronic pain conditions. Her approach is individualized to your specific needs and presentation and may include,

• Internal pelvic floor myofascial release work to help decompress the pudendal nerve. 

• Whole body treatment focusing on the fascial and biomechanical regions impacting the pelvis

• Breathing education

• Specific movement practices to help release tension in the pelvis and spine

• Mindfulness and meditation

• Lifestyle advice

Will I recover from Pudendal Neuralgia?

Yes. With the right treatment and management you can expect to make a full recovery. Our bodies are amazing and have enormous capacity to heal, allowing you to get back to living your full potential. 

What is Vulvodynia?

Before I explain what Vulvodynia is, let's have a little anatomy lesson. Let's talk about the vulva. The vulva is the external genitalia for someone who has a vagina, this is so important as many call both the inner and outer workings a vagina. Even my two year old calls her vulva, a vulva and I truly believe the sooner we are all comfortable using correct terminology without shame and embarrassment the better.

The vulva protects the vagina and urethra and is responsible for much of the sexual response for women. The vulva includes the labia (outer and inner), clitoris (please tell me you know about this???) the mons pubis and vestibule and anything in between. Check out the picture for a close up look. 

Back to Vulvodynia, vulvo means vulva and dynia means pain. So Vulvodynia means pain in the vulva, but can also include any burning, stinging, itching or irritation to the vulva. Vulvodynia is not linked to a known cause and is considered a chronic pain condition that has been present for longer than three months.

Ouchy.. No thanks.

Then comes sub categories.. Clitorodynia - meaning pain in the clitoris and Vestibulodynia, pain in the vestibule region of the vulva. 

Regardless of where the pain is and what type of pain is experienced, those with Vulvodynia are all in chronic pain, and many suffer with anxiety. Wearing underwear and tight pants can be uncomfortable and vaginal penetration is usually painful,  there can be vaginal pressure and burning and many have urinary symptoms of, 

• Urgency

• Increased frequency

• Incomplete emptying

• Burning sensation with urination

• Light bladder leakage

What causes Vulvodynia?

Part of the classification of Vulvodynia is that the cause is unknown. So what do we know? We know that Vulvodynia is usually associated with potential factors. These include;

• Hormonal, the vestibule is very sensitive to estrogen and androgens, where imbalances can result in irritation. 

• Musculoskeletal components - 90% of those with vulvodynia also have overactive pelvic floor muscles, and then there are other myofascial and biomechanical factors that can influence pain in the vulva. 

• Inflammatory conditions such as Lichen sclerosus and Lichen planus

• Infections - recurring conditions such as bacterial vaginosis and thrush. 

• Nerve related, in pain. For some this is due to neuroproliferation - too many nerve endings in the area, for others there is irritation to the nerves supplying the vulva e.g. pudendal nerve.

• Iatrogenic, meaning it is related to a medical procedure, postoperative pain, cancer treatment, hormone therapy, trauma and lacerations associated with childbirth or genital mutilation.

How do we treat vulvodynia?

Firstly, any infections or inflammatory conditions need to be identified and managed.

Kathryn Johns is extensively trained in the area of vulvodynia, where she uses a combination of techniques including internal pelvic floor myofascial release (with consent), this can help to decompress the main nerve (pudendal) that supplies and refers pain to the vulva and help relieve tension in the overactive pelvic floor muscles.  Externally, there is body work to the fascia leading to the vulva and the muscle, nerves and joints that influence this area. 

Kathryn works closely with the other osteopaths in the clinic with our Vulvodynia patients. Kathryn concentrates on the pelvic health components, and our other experienced osteopaths work on the external components contributing to this condition. 

As vulvodynia is a chronic pain condition and with this comes a nervous system that is over-stimulated, part of the treatment is focused on helping to calm the nervous system down using gentle osteopathic techniques. 

We also give advice on lifestyle, breathing patterns, prescribe movement practices and mindfulness.

What is Vaginismus?

Vaginismus is a condition where the vaginal muscles, aka the pelvic floor muscles, involuntarily contract in association with vaginal penetration. This can make it very painful and or difficult for not just a penis to enter, but those who experience vaginismus may also have difficulty inserting a finger, a tampon or menstrual cup, sex toy or participate in a pelvic exam using a speculum. 

Vaginismus is the leading cause of unconsummated marriage and a major cause of dyspareunia (the blanket term for painful sex).

Vaginismus is classified into two categories. Primary, meaning it was present from the first time vaginal penetration was attempted and Secondary, meaning the person had gone through a period of no symptoms with vaginal penetration before symptoms began. 

Does vaginismus result in pain?

Many experience pain, for others there is no pain. For them it may feel like their partner’s penis (or tampon, sex toy, finger etc.) is hitting a wall as the vaginal muscles contract, preventing or making entrance difficult.

When pain is experienced with vaginismus, it is usually accompanied with fear and anxiety, a complex pain cycle can be the result, making vaginismus difficult to fix at home without the help from medical healthcare providers.

How is vaginismus treated? 

Kathryn, has years of experience treating and helping those with vaginismus, and has completed extensive training in female sexual disorders. Her approach to the treatment of vaginismus is very holistic and may include; internal and/or external pelvic floor myofascial release work, stress management, working with breathing strategies, improving posture and alignment and general osteopathic techniques. Kathryn has a major emphasis on the fascia and the fascial lines present in the body that impact the pelvic floor and the breath.

Kathryn works closely with the team of osteopaths at Eastern Osteopathy where patients regularly see Kathryn for internal pelvic floor myofascial treatment and specific chronic pelvic pain treatment while also seeing the other osteopaths if general treatment is required. Our osteopaths will educate their patients on movement practices to help lengthen the pelvic floor, breathing and meditation to assist with anxiety and stress, and the appropriate use of dilators to ensure all facets of their patients’ care are met.

What is Bladder Pain Syndrome/interstitial cystitis ?

What is Bladder Pain Syndrome/Interstitial Cystitis ?

A little bit of anatomy first, the bladder is a muscular organ that receives filtered urine from the kidneys. As the bladder fills the bladder wall is stretched. This stretch automatically sends information to your brain, making your brain aware of how full the bladder is and when it will be an appropriate time to wee. When the time is right you will feel the urge to void and, with that sensation, look for a toilet. 

Bladder pain syndrome (BPS/IC) typically involves bladder hypersensitivity with symptoms of bladder urgency, frequency and pelvic pain in the absence of any infection. In extreme cases it is common to visit the toilet in excess of 40 times a day. 

BPS is a complex pain condition involving the bladder, pelvic floor and nervous system. 

BPS is more common in women than in men and it is estimated that 1.2 million Australians are living with this condition. BPS is often associated with negative cognitive, behavioural, sexual or emotional consequences and can be linked to a reduced quality of life (Engeler et al, 2020).

What are BPB/IC symptoms?

Symptoms vary between individuals, but can include,

• Suprapubic pain (pain above the pubic bone)

• Bladder pain and pressure with filling, that is not relieved with a void

• Burning sensation with a void

• Increased urgency and frequency of void

• Vulva pain - vulvodynia 

• Phantom UTIs

• Generalised back hip and pelvic pain

• Dyspareunia - general term for painful intercourse 

What causes BPS/IC?

There is much debate on this topic, and no consensus; some believe it is caused by Hunner’s lesions, a dysfunction in the lining of the bladder. However only 10% of those with BPS have these lesions. 

What we do know is that 87% of those with the condition have overactive, tight pelvic floor muscles (Peters et al, 2007). We also know that these muscles, when tight, can cause referral patterns that mimic the sensation of urgency and/or bladder pain. When these muscles are released it gives the bladder an opportunity to function optimally. 

We also know that after having experienced 3 UTIs the bladder can be up-regulated, making it easily irritated.  

How do we treat Bladder Pain Syndrome?

According to the American Urology Association, pelvic floor therapy is the first line of treatment for BPS/IC. 

Kathryn, our pelvic health trained osteopath has completed extensive training in the field of BPS/IC where she has studied under and been mentored by some of the world's leading experts in pelvic health and BPS/IC. She has an incredible understanding of the anatomy and facial connections impacting both the bladder and the pelvic floor muscles. 

Kathryn believes in adapting a multi dimensional approach to treatment, including internal and external myofascial release to the pelvic floor muscles and the fascia supporting the urethra and bladder. Education and home exercises on breathing, yoga hip and spine movement practices and meditation along with self care and self compassion.  

Relaxed diaphragmatic breath with pelvic floor awareness

Today we present you with a short video of how to practise a relaxed diaphragmatic breath, with pelvic floor awareness. 

Why are relaxed diaphragmatic breaths important? Well … when we take a relaxed breath in, our thoracic diaphragm moves down and our pelvic floor lengthens and drops down slightly.  Then, when we breathe out, our thoracic diaphragm moves up and our pelvic floor shortens, as it contracts and lifts slightly.

This breathing allows our pelvic floor to lengthen and shorten in a natural physiological way, this action is vital for the optimal function of our pelvic floor.

At Eastern Osteopathy, we have noticed that many of our patients breathe using their upper chest, rather than allowing their breath to expand their lower ribs, belly and back. This upper chest breathing does not allow the pelvic floor muscles to lengthen and drop down when they breathe in. Over time, this type of breathing can cause the pelvic floor to shorten and may even cause issues with incontinence, urgency/frequency, or pelvic pain.

So it is definitely worth giving diaphragmatic breathing a go!

Chronic Pelvic Pain Awareness Month 2020

Chronic pelvic pain affects teenage girls, women (1 in 5) and men (1 in 12). It does not discriminate as it affects people of all ages, ethnicities and social backgrounds. Pelvic pain is categorised as any pain below your belly button and above your legs, the pain can also radiate into your lower back, buttocks or thighs. It can be dull or sharp; constant or intermittent; and it may be mild, moderate or severe.

Chronic (or persistant) pelvic pain (CPP) is when pain has been present for longer than 6 months and the pain is occurring either with the complete absence of tissue damage, or after the tissue has healed. 

Everyone’s experience with CPP is different and how it presents for each individual is also very different depending on the systems (genitourinary, gastrointestinal & reproductive) and structures (nerves, fascia, muscles, joints & ligaments) involved:

Common Symptoms in women may include:

• Pain when sitting

• Pain around the anus, vulva 

• Painful penetrative sex, this can be at the opening or with deep penetration

• Pain after sex

• Involuntary pelvic floor spasms  

• Painful urination, urgency and/or frequency

• Abdominal & groin pain

• Constipation

• Pelvic girdle pain

  • Sacroiliac pain,

  • Coccygeal pain and

  • Pubic symphysis pain. 

Common Symptoms in men may include:

• Pain when sitting

• Involuntary pelvic floor spasms  

• Painful urination, urgency and/or frequency

• Abdominal & groin pain

• Constipation

• Pelvic girdle pain

  • Sacroiliac pain,

  • Coccygeal pain and

  • Pubic symphysis pain

Headaches, migraines and TMJ pain (pain & compromised movement of the jaw &  surrounding muscles) are also very common complaints for people who suffer from CPP.  

Some possible causes or contributing factors of CPP include: 

• Overactive or non-relaxing pelvic floor muscles. Tension in these muscles can refer pain throughout your pelvic region and even mimic urgency, symptoms of thrush or bladder pain

• Irritation, injury or compression of a nerve in the pelvic region, eg pudendal nerve causing pudendal neuralgia 

• History of infection of the prostate, bladder or even chronic thrush can cause irritation to the pelvic floor and surrounding nerves and fascia

• Endometriosis, adenomyosis or PCOS. For women who suffer from these conditions, tension in the pelvic floor muscles can be a reaction to years of chronic pain and inflammation in the pelvis. This tension in the pelvic floor can refer pain throughout your pelvic region

• Pelvic inflammatory disease

• Injury or trauma to the area can directly impact ligaments, joints, fascia, muscle and nerves. Pain in the pelvic area can cause guarding and tension in pelvic floor muscles, impacting blood flow which may then cause local and referred pain

• Surgery. Many different surgeries (hysterectomy, hip surgery, pelvic organ prolapse & prostatectomy) can impact the pelvic floor and surrounding nerves and fascia and in turn cause pelvic pain

• Constipation

• Pregnancy & childbirth

• Crohn's disease, SIBO, Irritable bowel syndrome & Ulcerative colitis. For women who suffer from these conditions, tension in the pelvic floor muscles can be a reaction to years of chronic pain and inflammation in the abdomen. This tension can refer pain throughout their pelvic regions

• Emotional factors such as mood or past or current abuse

• Lifestyle considerations, such as high stress, can cause guarding and tension in the pelvic floor muscles and surrounding fascia and nerves

As osteopaths with a passion for helping both men and women with pelvic pain, we recognise the role the central nervous system (the brain and spinal cord) have in the perception of pain. The CNS is always involved to a lesser or greater extent and it is our job to identify how much of a role it plays in our patients' pain picture. Doing this helps us create a management plan to best accommodate the needs of our patients. 

How can osteopathy help me with my chronic pelvic pain?

Everyone’s story is different, and everyone’s experience of pain is also very different. There is no ‘one size fits all’ approach to treating chronic pelvic pain. As osteopaths we are always searching for the WHY? The reality is that for most people with CPP, there isn’t just one incident or event that has caused their pelvic pain. There are generally a number of events or conditions that compound, to collectively contribute to, or help perpetuate their pelvic pain. 

The majority of pelvic pain cases have a neuromuscular component (pelvic floor muscle, nerves, ligaments & fascia) and a nervous system component (brain & spinal cord). It is important to identify any contributing factors or events (fall to your bottom, constant sitting, previous history of infection, endometriosis, surgery to your pelvis etc.) throughout your life that could be impacting not only on your perception of pain but also directly on your pelvic floor and surrounding tissues.

CASE HISTORY

A thorough case history is taken, including the full history of your presenting complaint as well as, past medical history and any relevant traumas, surgery etc. This helps us start to create a picture of your situation and formulate an hypothesis as to why you may be experiencing CPP.

WHOLE BODY ASSESSMENT & TREATMENT.

The emphasis of our treatment is on the whole person. It is important for us to identify whole body strain patterns that may be impacting your alignment and biomechanics. We aim to identify areas that could be either directly causing your pelvic pain or predisposing you to pelvic pain.

Osteopathic treatment will also be aimed at helping remove any stress or strain through the fascia (inc visceral region), muscles, ligaments and joints that may be loading your central nervous system. We use manual therapy techniques to help relax your nervous system, therefore helping create a higher threshold for activity.

INTERNAL ASSESSMENT OF YOU PELVIC FLOOR

An internal assessment of your pelvic floor can also be an extremely useful tool in diagnosing and treating CPP.  CPP more often than not will have a significant pelvic floor component that is either a driver to your pain or is helping to perpetuate your pain picture. We use manual therapy techniques to release your pelvic floor, which may include external and internal myofascial techniques. 

MANAGEMENT 

Chronic pelvic pain is a complex condition. Management is an essential part of your treatment plan.

Some important factors;

• Education regarding how to perform relaxed diaphragmatic breathing; explaining how to use your breath to relax tension (down regulation) of your muscles including your pelvic floor and how your breath can be used to relax your sympathetic nervous system that is heightened by stress - as commonly seen with those suffering with chronic pain.  

• Good toilet habits; education regarding good toilet habits, including the use of the squatty potty, mindfulness and breathing when going to the toilet, can help to relax the pelvic floor, allowing for ease of bowel movement and the reduction of stress on your pelvic floor.

• Mindfulness has been shown to reduce the perception of pain and stress levels

• Restorative yoga can help calm your central nervous system

• Movement practises. Move, move, move. Getting your body moving in a gentle way and getting back in touch with your body, can assist in your ability to trust in your body again. This is vital as it allows your brain to receive stimulus that you are moving, pain free and without fear. 

• Gentle Yin Yoga stretches to help any muscles and fascia that are restricting movement of your pelvic floor, abdominal and pelvic region.

•  Advice on sleep. When sleeping, our body has time to recharge and recover and reduce stress, so sleep patterns and behaviours are of vital importance.

• Nutritional advice. Removing inflammatory ingredients such as gluten, refined sugar and dairy can have a positive impact on pain. Not to mention that good nutrition is essential for good GUT health, which can also be a very important part of your management strategies.

• Chew, chew and chew some more. Mindfully and slowly chewing your food fully, can help get the gastric juices flowing, and by doing so this can help your stomach fully digest your food. This is an important first step in developing a healthy GUT which can in turn help reduce inflammation and pain.

The complex nature of CPP means that sometimes we find a multidisciplinary approach involving a variety of health and wellness practitioners is the most effective way to achieve overall health. When required, we will refer to naturopaths, acupuncturists, GP, pain psychologists as a part of our holistic approach to the management of pelvic pain.