A Cock in the Hen House: A look inside the Male Anatomy

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rooster-71685_640By Rachel Gelman

Recently, a male patient made my jaw drop. It happened during treatment, when he proceeded to inform me that he has always thought his pelvis was an empty space filled with veins. Say what?! A bigger shock was that he believed most of his male friends also thought the same thing and are completely unaware of the muscles in their pelvis! Now it may be because I am a PHRC therapist with extensive training in human anatomy, but I’ve always been under the impression that men are more aware of their nether regions. After all, their genitalia is more external and easier to view. However, after this conversation with my patient, I felt that perhaps I assumed incorrectly, and thus an anatomy lesson may be in order.

Although the external anatomy is different, all the other internal muscles that make up the pelvic floor are the same for men and women. The muscles sit in the pelvis like a muscular bowl, providing support to the organs of the pelvis and assisting in bowel, bladder, and sexual function.  In women, the pelvic floor supports the uterus, the bladder, and the colon. In men, the pelvic floor supports the prostate as well as the bladder and the colon. Now that we’ve established that  internally things are pretty similar, let’s take a closer look at the differences and talk about the male external genitalia.

First on the list is the male sex organ, the penis. It is comprised of several parts but for simplicity’s sake I will divide it into three components:

  •      The glans: Is the rounded head of the penis. In uncircumcised men it is usually covered by foreskin (I will discuss foreskin more thoroughly in a later blog post, so stay tuned!). The opening of the urethra is located in the glans. Fun fact: the glans is considered homologous to the clitoris in women!
  •      The shaft: Contains the erectile tissue of the penis, known as the corpus spongiosum and corpus cavernosum. When these tissues become engorged with blood the penis becomes erect. Also within the shaft of the penis is the urethra where both urine and semen travel to exit the body.
  •      The base: The area of the penis that connects to the lower abdomen. The root of the penis, which is under the skin, attaches to the pelvis via several tough ligaments.

Below the penis is the scrotum, a pouch of skin, which acts kind of like an anatomical satchel, and holds the testicles, which are the male sex glands. Sperm is produced and stored in the testicles. During sexual arousal an increase in blood flow occurs which allows for the penis to become erect, but also causes the testicles to increase in size! Luckily, there is some extra leg room in the scrotum because it is estimated the testicles can swell up to 50% of their normal size during sexual arousal! If a man does not ejaculate the pressure from the build up of blood and fluid in his genitals can lead to pain and discomfort also known as vasocongestion or “blue balls.” However, a man’s testicles do not actually turn blue; there may be bluish discoloration from the increased blood flow, much like a bruise.

Below the scrotum and right above the anus is a small patch of skin known as the perineum. It is very easy to dismiss this part of the body, but don’t do it! Men, the perineum is more important than it looks. Beneath the perineum are the superficial pelvic floor muscles, also known as the urogenital triangle. These muscles are responsible for obtaining and maintaining an erection, as well as assisting in ejaculation, and urinary function.  Since the perineum houses all of these muscles, there are tons of nerves that travel into the area, making this a small but important and often overlooked erogenous zone. The perineum, which some experts lovingly refer to as “the P-Spot,” provides indirect access to the prostate, a gland that secretes a fluid which combines with sperm to make semen. Due to it’s involvement during ejaculation and sexual function, as well as its position in the pelvis, it is a HIGHLY sensitive structure. (It is because of this increased sensitivity that makes this area vulnerable to injury and can be a source of pelvic pain). If stimulated, the prostate can induce a more powerful orgasm. Due to it’s proximity to the anterior rectal wall, stimulation can be achieved rectally, but if that isn’t your-or your partner’s-cup of tea, one can also massage the perineum to stimulate the prostate. P-Spot stimulation can be safely integrated into foreplay, but as with any sexual activity, be sure you communicate with your partner when trying this out for the first time.

Charlie Glickman, a Certified Somatic Sexuality Educator, recommends “[stimulating this area] during oral sex or erotic massage. Some intercourse positions like rear entry allow the giver to massage it. And of course,  you can include it in solo sex (aka masturbation).” I recommend checking out Charlie’s website, which has a great article on giving a prostate massage without penetration. So go ahead, pick your favorite explorer (I am partial to Magellan), and begin exploring some uncharted territory! You may not conqueror a new land ladies and gents, but your partner may thank you, especially if you provide him with your new anatomical knowledge.

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png;base645f5d78b840c97bb3So, now that you know more about the male anatomy let’s discuss the reasons why men might need pelvic floor physical therapy. Well, just like their female counterparts, men often present with similar complaints such as:

Pelvic pain

  • penile/scrotal/perineal or anal pain
  • tailbone pain/coccydynia
  • pelvic pain that interferes with sitting and exercise
  • groin pain
  • sacroiliac joint dysfunction

Urinary dysfunction

  • urinary urgency, frequency and hesitancy
  • decreased force of urinary stream
  • incontinence following prostatectomy

Sexual dysfunction

  • post-ejaculatory pain
  • erectile dysfunction

Bowel Dysfunction

  • Constipation
  • penile/perineal pain after bowel movements

Ahh, now comes the most commonly asked question from male patients, “If a man doesn’t have a vagina, how do you access the pelvic floor?” Well, the superficial muscles can be palpated externally, but to really evaluate the male pelvic floor, a therapist must perform an internal rectal examination ( I should mention that a rectal exam is sometimes also performed on female patients, but only in certain situations). As you may have guessed, not all of my patients are excited about  a rectal exam. Even my cat dreads his trip to the vet because of it, but a rectal examination is the only way to fully assess the quality of those muscles! For more information about what else happens during an exam, check out Malinda’s blog on male pelvic pain/prostatitis.

I hope this blog has helped you understand the basics of male anatomy and perhaps given you a few tips to spice up intimacy with your partner! If you want to learn more, check out these links for additional information:

(Depending on where you work, these sites may be NSFW)

http://pspotbook.com/

http://www.webmd.com/men/picture-of-the-penis

http://www.innerbody.com/image/repmov.html

http://www.ashasexualhealth.org/sexual-health/mens-health/

Readers we want to hear from you! What questions do you have about male or female anatomy? And if you haven’t already, SUBSCRIBE to this blog (up top, to the right, under Stephanie’s photo!), so you can get weekly updates in your inbox, and follow us on Facebook and Twitter where the conversation on pelvic health is ongoing!

Regards,

Rachel Gelman, DPT

Rachel-profile-pic2Rachel Gelman is a Bay Area native, and currently practices in our San Francisco office. She received her bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. Rachel grew up dancing and is excited to have recently returned to the dance studio. Outside of dance, Rachel enjoys going to the gym, discovering new brunch spots and spoiling her adorable niece and nephew.


9 thoughts on “A Cock in the Hen House: A look inside the Male Anatomy

  1. WOW… this is an excellent article and I have sent it to other physical therapists that will be able to forward to their male clients. Lots to read and take in. Thanks for this! I will post the link from my website to this as well.

  2. Thanks Rachel for the excellent article.

    I wonder if you can comment on maintaining boundaries with your physical therapist. After a few months of pelvic PT I developed an inappropriate emotional attachment to my PT. I knew there would be rectal exams but I underestimated how the overall treatment program would affect me. I’m no longer seeing her and I am reluctant to pursue any further pelvic PT to avoid making the same mistake.

    I found it quite an intense experience:
    – Very intimate conversations with a caring person
    – Hands on touching -external and and also very intimate touching

    The PT was extremely professional. At no time did she act inappropriately: no jokes, no hugging, no contact outside the clinical setting. The inappropriate thoughts are all on me.

    Suggestions for how I can handle this better next time?

    • Hello Nick,

      Yes, pelvic physical therapy is unique and rather intimate, but you should always feel comfortable to communicate with your therapist if you sense there is an “inappropriate emotional attachment.”

      Regards,

      Rachel

  3. I am a recreational cyclist riding about 120-150 miles per week, recently I have experienced pain in the tissue that surrounds the pubis-ischium on my left side. Visited my doctor and he prescribed Prednisone and to get off the bike for 2-3 weeks, the latter hard to do; the Prednisone seemed to help some, but as soon as I got back riding I experienced the same symptoms as before. The pain is not excruciating, just uncomfortable when riding for an extended period of time.

    • Hello Dario,

      We often see avid cyclists who present with similar symptoms. It will be necessary for you to receive an evaluation to be sure, but it sounds like there may be a musculoskeletal impairment present. Manual therapy from a pelvic floor physical therapist will be able to address these issues.

      All my best,

      Rachel

  4. Pingback:Yes, Men can have pelvic pain too. | Jessica Reale, PT, DPT, WCS

  5. Hello, I have a syndrome called progressive Mylopathy caused by a artery that had surrounded my spinal cord causing damage to my nerves below the waist affecting my walking bladder & many muscle groups around the perinium, resulting in pain sitting down. I had a laminectomy in 2009 to remove the artery from spinal cord but spasms still remain below the waist etc & my urethral valve closed so I have a super pubic catheter in place to drain bladder now. I do regular stretches for my leg muscles now & reduced my Botox injections to legs from 1250 units to 250 units.

    Can you recommend an exercise I can do to elevate the pain I experience when sitting down as it’s extremely painfull. I live in the UK

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