Male Pelvic Floor: Advanced Massage and Bodywork for Tension, Dysfunction, and Pain

Pelvic Floor Massage and Bodywork

Massage and bodywork is a wonderful way to more fully connect with your pelvic floor and begin to gain an awareness of its role in your life. It is an essential part of your core musculature and is thus integral to movement, support, and respiration. It also has a very strong influence on the health of the organs it cradles: the prostate, bladder, and rectum—as well as the genitals. Sexual arousal, erectile function, ejaculation, orgasm, urination, and bowel function would be severely compromised without the central role of the pelvic floor. Various emotions such as fear and anger can both originate and become embedded in these muscles, and it is a powerful energy center. This area is rich in nerve endings and thus can be a source of great pleasure—or much pain.

For many men, experiencing pelvic floor bodywork is a journey of discovery, a way to more fully experience and deeply inhabit their body. I strive to create a non-judgemental space in which you feel safe and comfortable, and give you an experience that is warm, engaging, informative, and effective. Working with the male pelvic floor—which is more complex than the female pelvic floor—requires an informed and sensitive touch, a clear understanding of the relevant anatomy, and respect for boundaries.

Techniques I use to mobilize, stretch, release, and improve the function of the muscles, connective tissues, and organs of the pelvic floor are drawn from Neuromuscular Therapy, Myofascial Release, Orthopedic Massage, Sports Massage (I was among the first to become nationally certified in Sports Massage and have worked with athletes at the Olympics, the Boston Marathon, and with the U.S. Olympic Judo team), Deep Tissue Massage, Trigger Point Release, Swedish Massage, Cross-Fiber Manipulation, Positional Release, Trager Bodywork, and other modalities. To help you isolate and feel these muscles I may use Active Engagement techniques, in which I ask for mild contractions followed by full relaxation of the pelvic floor muscles as I gently apply pressure to various myofascial structures. This approach has the added benefit of enhancing tissue release and stretch as well as deepening awareness, connection, and control. In addition, I may include active or passive pelvic and leg movements to further stretch and open muscles and connective tissues that I am working on (often referred to simply as Pin and Stretch Technique, an approach very similar to Active Release Technique). I teach clients how to connect the breath to the pelvic floor and how to use this valuable tool to further stretch, open, and release the pelvic floor and abdominal tissues. When indicated, I assess pelvic floor strength and endurance—and teach clients how to strengthen these muscles if needed.

There are two main approaches to pelvic floor bodywork: external and internal. For some readers the information below may seem a bit overwhelming and too detailed or technical; feel free to scan the topics to get a sense of what pelvic floor bodywork can entail and read only those sections of particular interest. While I often include conditions, pain syndromes, and other dysfunctions that specific muscles or muscle groups are especially relevant to, keep in mind that no muscle operates in isolation and treating the pelvic floor and wider region as an integrated whole ensures better outcomes. Further, pelvic floor bodywork is not only about addressing dys function and pain, and is just as much about improving function and enhancing your ability to inhabit this part of your body with greater comfort, ease, openness, vitality, pleasure, groundedness, and integrity. Explorers and seekers who have no issues with their pelvic floor can benefit from pelvic floor bodywork just as much as those who do. These two groups are not at all mutually exclusive.

Section and subsection links:

External Pelvic Floor Bodywork

The bulbospongiosus muscleThe ischiocavernosus musclesThe superficial transverse perineal musclesThe deep transverse perineal muscleThe external anal sphincter and the external urethral sphincterThe levator ani muscle groupThe pelvic floor attachments on the inside border of the sit bonesThe obturator internus musclesThe perineal bodyThe anococcygeal ligament and tailboneThe ischioanal fossa

Closely Associated Muscles, Connective Tissues, and Other Structures

The suspensory ligaments of the penisThe foreskinThe muscles of the penis, and penile rehabilitationThe penile urethraThe muscles and connective tissues of the inguinal, pubic, and groin regionThe cremaster musclesThe testicles and epididymes

Internal Pelvic Floor Bodywork

The external and internal anal sphinctersThe perineal body, deep transverse perineal muscle, and external urethral sphincterThe levator ani and coccygeus musclesThe anococcygeal ligament and tailboneThe prostate gland and prostate massageThe obturator internus muscles

A Note about Sexual Energy and Erections

Core Bodywork


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External Pelvic Floor Bodywork

The external approach engages these muscles in the same way that most other muscles of the body are massaged, mobilized, stretched, and released: by using pressure and movement on and through the skin. Many pelvic floor muscles can be accessed in this way and external pelvic floor bodywork is by far the most direct and easiest approach for some of them (i.e. bulbospongiosus and ischiocavernosus muscles, for example). Several additional closely associated myofascial tissues—the suspensory ligaments of the penis, the cremaster muscles, the groin and inguinal tissues, the foreskin, and various other structures that I discuss below—can be valuable additions to external pelvic floor bodywork.

External pelvic floor bodywork is the foundation of my pelvic floor approach and is always a logical and practical starting point for several reasons: it directly engages or influences the entire pelvic floor; it is effective in addressing many instances of discomfort, pain, and dysfunction on its own; it is an excellent way for clients to learn about and explore the landscape of their pelvic floor in an experiential, felt-sense way; and it facilitates, complements, and augments internal pelvic floor bodywork when that is included. External work can be deeply relaxing both locally and globally (i.e. to the entire body) via its strong effects on the autonomic nervous system, and is equally useful for those who have specific issues or concerns they want to address as well as for those who simply wish to experience and explore this critical but overlooked part of their bodies in a bodywork context.

Regardless of the motivation for seeking out my work, I will give you a pelvic floor bodywork session that is comfortable, informative, and effective, with the intention of creating an extraordinary experience for each client. Bringing an open mind and a willingness to explore is an excellent way to approach this work.

External pelvic floor bodywork includes all of the following major muscles (see my Anatomy and Function page, especially Figure 4, for illustrations of these muscles). Muscles are in red text; ligaments and other important connective tissues are in green text.

Several highly relevant pelvic floor structures beyond the main muscles described above are also included with external pelvic floor work. Among them:

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Closely associated muscles, connective tissues, and other structures:

Depending upon the issues, concerns, and goals of each client and his level of comfort and trust, external bodywork may include additional pelvic and genital structures, as described below. All of my work is permission-based and every client has the right to determine what is included and what is not; I explain, describe, and discuss all options as part of the informed consent process so that each client fully understands the rationale behind, and value of, each option. For most men, pelvic floor bodywork is new and includes areas that have not been part of previous bodywork sessions. Agency and autonomy are important and boundaries are always respected. Having said that, when permission is given the following muscles, connective tissues, and other structures may be included:

External bodywork targeting some or all of the above myofascial tissues and structures is an excellent way to more fully explore, experience, and inhabit the often ignored yet crucial landscape of the male pelvic floor and pelvic region, and to enhance awareness, control, function, and vitality in these areas. It also is a valuable and effective way to address many symptoms, conditions, dysfunctions, and pain syndromes associated with the pelvic floor, perineum, genitals, groin, inguinal and pubic areas, and lower abdomen, as described above. Moreover, it frequently has positive effects on the wider region—hips and low back, for example—due to the extensive structural and functional relationships between all of these core areas.

Speaking of the core, some readers may wish to look at the information on my companion website My Core Bodywork page on that site lists and describes several categories of men—Explorers, Sufferers, Optimizers, Survivors, Power Users, and Seekers—and how each of these groups can benefit from pelvic floor bodywork by itself or as part of my broader core work. It also includes numerous testimonials from clients describing, in personal terms, the impact and significance of our work together.

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Internal Pelvic Floor Bodywork

The internal approach accesses and engages the muscles, connective tissues, and organs discussed below via the anal canal and rectal wall. Gloves or cots are worn, lubrication is used to facilitate entry, and a finger is then gently inserted to varying depths and oriented in different directions depending upon the target tissues. Placement, pressure, movement, pace, technique, and verbal cues are important factors and are employed in a way that enables each client to accommodate the work as comfortably as possible. Maintaining open communication is essential.

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A Note about Sexual Energy and Erections

Many of the core muscles and sensory nerves—especially those of the lower abdomen, groin, and pelvic floor—are associated with sexual arousal and response. Thus, working in these areas can give rise to sexual energy in response to physical contact and engagement. This can be a source of anxiety for some men who may wonder: "What if I get an erection?"—which can lead to another question and perhaps bigger fear: "What if I happen to ejaculate?" The physiology of erection and ejaculation is complex and both responses are frequently not within our voluntary control—and can occur regardless of intention. Some men never get erect during a bodywork session, some have intermittent erections, and some are erect for the majority of the time. If and when erections occur, I regard them as a normal response and a non-issue. If a client happens to ejaculate during a session, I allay any feelings of discomfort, embarrassment or shame he may exhibit, and reassure him that he did nothing wrong. Communication, dialogue, and maintaining an open, non-judgemental attitude are essential.

Consider the following two points:

My suggestion to clients is to allow all sensations and responses to happen without worry or censure.

Reference: 1. Ventegodt, S. The Nobel Prize in Medicine Should Go To Dean Ornish. BMJ, 2010;341:c5715

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Core Bodywork

'No man is an island' as the saying goes, and this certainly applies to various parts of ourselves including the pelvic floor. It interoperates with and has close relationships to the pelvis as a whole, the thighs and hips, the spine and back, the abdomen and chest, and parts of ourselves beyond these immediate neighbors. Work in these areas benefits the pelvic floor, and vice versa. As noted above, my companion site has more details about my core work and how it intersects with pelvic floor bodywork.

Bodyworkers and massage therapists who are interested in adding pelvic floor manual therapy techniques and protocols to their current skill set can contact me about organizing and/or hosting a male pelvic floor training in your city or state. Back to top

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"What can I say, you are a good man. I really appreciate all of the information on top of everything we discussed on Thursday. I was really relaxed about my situation on Friday. The fact that I have even discovered the pelvic floor and the fact that it was without doubt the cause of all my issues is huge in itself. So thank you again."

"Your pelvic floor work is way more comprehensive than the two pelvic floor PTs [physical therapists] I have worked with."

"First of all I wanted to thank you for the first treatment we had as I have no pain in my hip as a result of your working that out, honestly thank you. Having never experienced this practice before I am certainly responsive to the therapy and have felt safe in your care. I would like to schedule another session with you [...] and would like to let you guide the session and experience as you wish to, I am totally open to the process."

"There was a lot about it that was so life-changing [...] [the internal pelvic floor and prostate work we did] was transcending."

"Our session was absolutely amazing. Your work is phenomenal, and I love the detail and depth. You have great hands and I trust your touch."

"The pelvic floor massage made me a little nervous at first... but it was total bliss to let go and just relax and enjoy the touch. You are really gifted and you're very gifted in your ability to put people at ease. I could not have gone to the limit of experience today had I not felt the room to go there."

"it was awesome to have the opportunity to work with you via Zoom. I can tell how passionate and knowledgable you are. It would be great to get the opportunity to see you as a client in person someday. Who knows if I will ever get the opportunity, but I appreciate all of the resources and tools to add to the tool box right now. I can't wait to dig in. Thank you again for your time, knowledge, resources, and encouragement. It really means a lot to me."

"Jeff, thank you very much for yesterday. Enormously helpful and encouraging. You are a great teacher—so clear."

"Absolutely amazing. You are a true artist. Life-changing in many ways. Sensations I have never experienced. [...] you elicited feelings I've never had before. [... ] incredible, wonderful, [it] truly was amazing."

"I appreciate the help you've given me over the years. I'd be in pain without it."

"I sense through the work we do together that you are a very giving and generous sort when it comes to your time, thoughtfulness and intention. [...] Also, as always, thank you from the deepest part of me for the work yesterday. It was quite impacting on many different levels."

"That was such a powerful session for me."

"Putting my gratitude in writing feels important. Your intuitive body wisdom, your kindness and care, your patience have all been incredibly supportive for me, both in my life and my spiritual practice. Your skilled bodywork has been an important support over many years. Words, actually, don't fully express the gratitude I feel for you. A deep bow of gratitude."

"You are amazing and you truly have a passion to help people heal their bodies."

"This has been one of the most enlightening conversations I've had in the last ten years."

"Thank you! It was really a pleasure. I already have big improvements from BC [bulbospongiosus muscle] massage. I realize how much hard flaccid I have [been living] with. I sense way more and not so tense. My penis is spongy lol.. more blood flow. Very big difference yet still a long way to go. I am happy about it though."

"It is such a relief from the rectal spasms and I am truly grateful that the treatment with you lessened the frequency of them significantly."

"My utter gratitude to you for the work we did yesterday.  I’ve been so contemplative since noon yesterday. I feel that this is just the beginning of a better connectivity between me and my body. Thanks so much! "

"Thank you for the additional information. I learned a lot during our session and I hope to be more conscious of those things in my daily routine. I’ve definitely noticed that my erections are stronger which makes sense. If I come back to SF, I’ll be sure to contact you. Thanks again."

"I felt honored [during our pelvic floor bodywork session] rather than abused [referring to his childhood sexual abuse]."

"I just wanted to let you know that the day after our session I felt a LOT more relaxed and actually had a morning erection ( I rarely have that). But the big thing was I could feel a relaxing buzz in my perineum (maybe near my root chakra?). And I quickly realized if I relaxed enough and focused on the buzzing sensation I could make it feel more pleasurable. The sensation has faded away, but it was definitely a great new feeling."

"Thanks for the masterful massage yesterday Jeff. Truly one of a kind. I enjoyed it very much and was extremely relaxed the entire time." [...] "Can't keep praising your massage enough!"

"Thanks for the resources. [...] Very helpful. Just wanted to say how much I appreciated being heard and validated when I spoke with you. I’ve never had a medical professional ever say anything like that."

"Talking to you has probably been the biggest help, and understanding what I'm going through."

"I would like to be personally evaluated by you, as you've been the most knowledgeable professional I've worked with pertaining to this issue."

"My name is [...]. I was [alerted to] you and your amazing work through taking a male pelvic floor physical therapy course through the APTA. I believe one of the slides had some of your artwork and the instructor gave you credit and mentioned that you were such an amazing resource. I proceeded to look you up and I concur, you are an AMAZING resource!"

"You have such gifted, healing hands and I so appreciate that. Thank you."Back to top