I recently had the pleasure of presenting on multiple conditions impacting men’s sex life at the Guelph Sexuality Conference. Along with two of my colleagues from Proactive Pelvic Health Centre, I presented on An Integrated Approach to Pelvic Health Conditions in Males to an audience of counsellors, therapists, sex educators, and other clinicians involved in the treatment of sexual conditions. It was a terrific opportunity to increase awareness about conditions impacting men’s sexuality that are often not talked about.
The conditions we discussed were erectile dysfunction, premature ejaculation, urologic chronic pelvic pain syndrome (UCPPS, also known as chronic non-bacterial prostatitis), interstitial cystitis/painful bladder syndrome, incontinence, and post-prostatectomy. While erectile dysfunctions talked about more frequently, due to medications that treat the condition, as discussed in my previous post medication does not address all the factors that can contribute to and maintain this condition.
In our presentation, we discussed the biopsychosocial factors that can contribute to each of these conditions, and the way that they are interrelated. For example, physical conditions that cause pain may lead to an increase in anxiety, which in turn leads to greater awareness of pain and more pain signals. At the same time, pain that impacts sexual function can lead to relationship distress and one or both partners may begin avoiding sexual activity so as to avoid a disappointing experience. Social factors may come into play in relation to how sex is defined (for example, when people consider that the only “real sex” is intercourse, they are more likely to miss out on enjoying sexual activities that are not impacted by pain or other pelvic conditions).
An integrated approach to pelvic conditions in men addresses all of the factors that contribute to sexual difficulty. This approach includes sex therapy for the psychological and relational factors (for example, by improving pain coping skills, and by reducing anxiety and the impact of the sexual problem on the relationship), mindfulness (as part of the sex therapy or as a separate treatment) to reduce anxiety and pain, and pelvic floor physical therapy to address muscle dysfunction.